Impact of Prebiotics, Probiotics and Synbiotics on Components of the Metabolic Syndrome

Research Article

Ann Nutr Disord & Ther. 2014;1(2): 1009.

Impact of Prebiotics, Probiotics and Synbiotics on Components of the Metabolic Syndrome

Scavuzzi BM1, Henrique FC2, Miglioranza LHS3, Simão ANC4 and Dichi I5*

1Department of Health Sciences, University of Londrina, Brazil

2Department of Food Science, University of Londrina, Brazil

3Department of Food Science and Technology, University of Londrina, Brazil

4Department of Pathology, University of Londrina, Brazil

5Departament of Internal Medicine, University of Londrina, Brazil

*Corresponding author: Dichi I, Department of Internal Medicine, University of Londrina, Rua Robert Koch n. 60, Londrina, Paraná, Brazil

Received: August 08, 2014; Accepted: September 02, 2014; Published: September 03, 2014


Changes in eating habits are undoubtedly the most important nonpharmacologic factor for the prevention and treatment of risk factors of metabolic syndrome and, therefore, nutritional therapies have been researched. The consumption of prebiotics, probiotics and synbiotics gained recognition from the scientific community due to the promising effects on health and well-documented history of safe use. Thus, this article presents a review of scientific studies investigating clinical responses of patients treated with prebiotics, probiotic or symbiotic, and raises the key issues to be considered by scientists in the search of dietary alternatives for patients suffering from metabolic syndrome.

Keywords: Dysbiosis; Obesity; Dyslipidemia; Insulin resistance; Inflammation


ALA: Alpha Linolenic Acid; B: Bifidobacterium; BMI: Body Mass Index; BP: Blood Pressure; CG: Chitin-Glucan; CRP: C-Reactive Protein; DB: Double-Blind; DBP: Diastolic Blood Pressure; FOS: Fructo Oligosaccharides; GLP-1: Glucagon-Like Peptide 1; HDL-C: HDL Cholesterol; HOMA: Homeostasis Model Assessment; hs- CRP: high-sensitive C-Reactive Protein; IL: Interleukin; IR: Insulin Resistance; L: Lactobacillus; LDL-C: LDL Cholesterol; Lp(a): Lipoprotein A; LPS: Plasma Lipopolysaccharide; MetS: Metabolic Syndrome; OFS: Oligofructose; OGTT: Oral Glucose Tolerance Test; OxLDL: Oxidized Low-Density Lipoprotein; PYY: Peptide YY; RCT: Randomized Control Trial; RCOT: Randomized Cross- Over Trial; RPCT: Randomized Placebo Controlled Trial; SBP: Systolic Blood Pressure; SCFA: Short-Chain Fatty Acids; T2D: Type 2 Diabetes Mellitus; TAC: Plasma Total Antioxidant Capacity; TC: Total Cholesterol; TG: Triglycerides; TNF-a: Tumor Necrosis Factoralpha; VLDL-C: VLDL Cholesterol.


Metabolic syndrome is a complex disorder represented by a cluster of cardiovascular risk factors associated with central fat deposition, abnormal plasma lipid levels, elevated blood pressure insulin resistance and intestinal dysbiosis [1-4]. Changes in eating habits are undoubtedly the most important non-pharmacological factor for the prevention and treatment of the risk factors of the MetS and various nutritional therapies have been researched [5,6]. Among the nutritional therapies to prevent MetS risk factors, the scientific literature has pointed to the consumption of probiotic, prebiotic and symbiotic products.

The gastrointestinal tract is composed of several connected organs that are involved in nutrient conversion and providing energy sources from the food absorbed. This complex system has a well-known anatomical architecture that is approximately 7m long, comprising 300m2 surface area in adults. The human large intestine has a bacterial flora with total numbers of 1014 cells, (ten times the number of the cells of the human body) more than 1000 species and a biomass superior 1Kg [7,8].

From the mouth to the colon, there is a complex micro biota consisted of facultative and strict anaerobes, including streptococci, bacteroides, lactobacilli and yeasts [9,10]. The micro biome comprises nearly two million genes, being the collective bacterial genome vastly greater than the human genome. The advent of high-through put methodologies and the elaboration of sophisticated analytic systems have facilitated the detailed description of the microbial constituents of the human gut as never before and are now enabling comparisons to be made between health and various disease states [11].

Currently, it has also been recognized that this dynamic yet stable ecosystem plays a role in conditions such as obesity and diabetes as well as in general well-being, from infancy to ageing [7,12-15]. The literature has demonstrated different gut microbial composition between non-diabetics and adults with T2D, and lean and obese individuals [7,16] and suggested that gut microbial composition may affect the metabolism and energy storage [17]. The main functions of the gut micro biota are ascribed into three categories: metabolic, protective and trophic [18].

A consensus definition of the term “probiotics” was adopted after a joint Food and Agricultural Organization of the United Nations and World Health Organization expert consultation. In October 2001, the Organizations experts defined probiotics as “live micro-organisms which, when administered in adequate amounts, confer a health benefit on the host.” The original idea of the probiotics concept (that can be translated in ‘probiotics effects’), was defined as: ‘the selective stimulation of growth and/or activity (ies) of one or a limited number of microbial genus (era)/species in the gut micro biota that confer(s) health benefits to the host.’ When probiotics and prebiotics are used in combination, they are known as synbiotics [19,20].

The consumption of prebiotics, probiotics and synbiotics has gained recognition from the scientific community due to the promising health effects and well documented history of safe use. Thus, the present review gathers recent and relevant literature found in at least 130 Databases included in the virtual library “Portal CAPES Consortia” (Higher Education Personnel Improvement Coordination –Brazil) published from 1994 to 2014, involving the consumption of prebiotics, probiotics and synbiotics and the components of the MS. There were no restriction groups, but searches have focused on texts written in English.


The modulation of the intestinal microbiota is one of the potential beneficial health effects of probiotics, and numerous research studies have documented that probiotics can impact the gut microbiota [21]. The mechanisms and efficiency of the probiotic effect depend primarily on the interactions between the probiotic microorganisms and either the microbiota of the host or the immunocompetent cells of the intestinal mucosa [22,23].

Dysbiosis of the intestinal microbiota has been associated with a growing number of diseases. Some data on the MetS suggest that changes in gut microbiome composition may play a role in the disorder. Recently, fecal microbiota transplant from non-diabetic donors infused into the duodenum of patients with the MetS improved their insulin sensitivity, highlighting the broad potential of this intervention [24]. Since modulation of the composition of intestinal microbiota by probiotics was demonstrated to be possible, this intervention has the potential to counterbalance intestinal Dysbiosis and thus restore health [22].

Probiotics may play a beneficial role in several medical conditions, including diarrhea, gastroenteritis, irritable bowel syndrome, inflammatory bowel disease, cancer, depressed immune function, infant allergies, failure-to-thrive, hyperlipidemia, hepatic diseases, Helicobacter pylori infections, and others [25].

The effects of probiotics are mediated by the role of probiotic bacteria in normalization of intestinal microbiota composition, immunomodulation, and maintenance of gut barrier function. With advancing knowledge of how probiotics interact with the gut microbiome, there is an increasing interest in exploring the effect of probiotics on specific elements of the MetS in humans [26].

Several strains of probiotics improve metabolic parameters such as hypertension, abnormal plasma lipid levels, obesity, inflammation and glucose homeostasis disorders [15,27-30]. The important criteria that have been put forward by FAO/WHO in the selection of food probiotics include identification of strains using state-ofthe- art techniques, ability to tolerate gastric juice and bile, maintain stability and, most importantly, prove to be safe and beneficial to the consumer. A number of genera of bacteria are used as probiotics, including Lactobacillus, Bifidobacterium, Pediococcus, Leuconostoc and Enterococcus [31]. Amongst probiotics, L. acidophilus NCFM / La5, L. casei subsp. casei, L. gasseri SBT2055, L. helveticus, L. plantarum 299v, L. rhamnosus GG, L. reuteri NCIMB, B. lactis Bb12 and others, have human health efficacy data with desirable properties and well-documented clinical effects on parameters of MetS [30,32- 36].

The physiological effects of probiotics are highly strain-dependent. The variations in outcomes between different studies appear to be due to choice of probiotic strain, route of administration and length of study. Human studies considering probiotics and components of the MetS are still under consideration.

Probiotics and body weight

Numerous studies of the human gut microbiome found evidence of core differences between lean and obese individuals, reduced diversity of the microbiota in obese individuals and suggested that gut microbial composition may affect the metabolism and fat storage [17,37-39],

Additionally, studies have recognized that the composition of the gut microbiota has an impact on energy homeostasis and suggested that probiotics have a positive impact on weight loss. However, it is important to mention that the physiological effects of probiotics are highly strain-dependent. Million et al., 2012, conducted a comparative meta-analysis of studies considering the effect of species of Lactobacillus on body weight of humans and animals. The authors found that the species fermentum and ingluviei were associated with weight gain in animals, plantarum was associated with weight loss in animals and gasseri was associated with weight reduction in animals and humans [40].

Five studies considering the impact of probiotics on body weight were considered for this review. All the studies documented improvements in this MetS parameter after probiotic consumption (Table 1). The mechanisms involved in the reported body weight reduction are not clear, but studies point out to the reduction of adipocyte size [41,42], inhibition of adiposeness [43] and the suppression of energy intake [44].