Effects of a multispecies synbiotic on glucose metabolism, lipid marker, gut microbiome composition, gut permeability, and quality of life in diabesity: a randomized, double-blind, placebo-controlled pilot study

Abstract

Purpose Diabesity, the combination of obesity and type 2 diabetes, is an ever-growing global health burden. Diabesityassociated dysbiosis of the intestinal microbiome has gained attention as a potential driver of disease and, therefore, a possible therapeutic target by means of pro-or prebiotic supplementation. This study tested the effects of a multispecies synbiotic (i.e. a combination of probiotics and prebiotics) on glucose metabolism, gut microbiota, gut permeability, neutrophil function and quality of life in treatment-experienced diabesity patients. Methods A randomized, double-blind, placebo-controlled pilot study with 26 diabesity patients was conducted in which patients received a daily dose of a multispecies probiotic and a prebiotic (or a placebo) for 6 months. Results There were no changes in glucose metabolism or mixed meal tolerance test responses throughout the study. The analysis of secondary outcomes revealed beneficial effects on hip circumference [− 1 (95% CI − 4; 3) vs +3 (− 1; 8) cm, synbiotics vs. placebo, respectively, p = 0.04], serum zonulin [− 0.04 (− 0.2; 0.1) vs +0.3 (− 0.05; 0.6) ng/ml, p = 0.004)] and the physical role item of the SF36 quality of life assessment [+ 5.4 (− 1.7; 12.5) vs − 5.0 (− 10.1; 0.2) points, p = 0.02] after 3 months of intervention, and lipoprotein (a) [− 2.1 (− 5.7; 1.6) vs +3.4 (− 0.9; 7.9) mg/dl, p = 0.02] after 6 months. There were no significant differences in alpha or beta diversity of the microbiome between groups or time points. Conclusions Glucose metabolism as the primary outcome was unchanged during the intervention with a multispecies synbiotic in patients with diabesity. Nevertheless, synbiotics improved some symptoms and biomarkers of type 2 diabetes and aspects of quality of life suggesting a potential role as adjuvant tool in the management of diabesity.

Changes in the Intestinal Microbiome during a Multispecies Probiotic Intervention in Compensated Cirrhosis

“…The increase of OTUs attributed to Synthrophococcus and Prevotella were correlated to a decrease in zonulin, an endogenous tight-junction regulating protein and is used as a biomarker for gut permeability, where high levels in stool or serum are indicative of a barrier dysfunction [46,47]. Decrease in zonulin levels during probiotic interventions has been shown before in obese patients with type 2 diabetes with the same product as used in the present study, and in healthy trained men with a comparable multispecies product [23,48]. Furthermore, the same product as in the presented trial showed a reduction of bacterial translocation in type 2 diabetic patients after a six month intervention and in postmenopausal women after 12 weeks [49,50].…”

The food-gut axis: lactic acid bacteria and their link to food, the gut microbiome and human health

“…In contrast, the same formulation was not effective at improving blood glycaemia in type 2 diabetes patients (Horvath et al . 2019 ). This highlights that a probiotic formulation should be designed to target a well-defined health outcome or population.…”

The Gut-Liver Axis in Cholestatic Liver Diseases

“…Zonulin in stool, which has been proposed to be pre-haptoglobin 2, modulates intracellular tight junctions and therefore regulates intestinal permeability [ 79 , 80 ]. It has been proven to be modifiable by microbiome targeted interventions [ 81 , 82 ]. The enzyme diamine oxidase (DAO), liable for oxidative deamination of histamine and present in the intestine from the duodenum to the ileum, inversely correlates with gut permeability of the small intestine when measured in serum and therefore represents a useful permeability marker, which is easier to obtain and store than stool samples [ 83 , 84 ].…”