title: Microbiota manipulation for weight change.
abstract: Manipulation of the intestinal microbiota has been linked to weight changes and obesity. To explore the influence of specific agents that alter the intestinal flora on weight in different patient groups we conducted a meta-analysis of randomized controlled trials (RCTs) reporting on the effects of probiotics, prebiotics, synbiotics, and antibiotics on weight. We searched the Pubmed and Cochrane Library databases for trials on adults, children, and infants evaluating the effects of these substances on weight. Our primary outcome was weight change from baseline. Standardized mean differences (SMDs) with 95% confidence intervals were calculated. We identified and included 13 adult, 17 children, and 23 infant RCTs. Effects were opposite among adults and children, showing weight loss among adults (SMD -0.54 [-0.83, -0.25)) and minor weight gains among children (SMD 0.20 [0.04, 0.36]) and infants (SMD 0.30 [-0.01, 0.62]) taking mainly Lactobacillus probiotic supplements. Heterogeneity was substantial in the adult and infant analyses and could not be explained by intervention or patient characteristics. Azithromycin administration in children with pulmonary disease was associated with weight gain (SMD 0.39 [0.24, 0.54]), without heterogeneity. A high risk of selective reporting and attrition bias was detected across the studies, making it difficult to draw firm conclusions. Overall, our meta-analysis suggests that there may be a role for probiotics in promoting weight loss in adults and weight gain in children, however additional studies are needed. Though we cannot recommend antibiotic administration for weight manipulation, its use provides advantageous weight gain in children with cystic fibrosis and bronchiectasis.
authors.affiliation: The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Tal
authors.initials: T
authors.lastname: Dror
authors.affiliation: Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Dickstein
authors.affiliation: Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, University, Hospital Centre Timone, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Assistance Publique - Hôpitaux de Marseille, Marseille, France; Université Aix-Marseille, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE) UM 63 CNRS 7278 IRD 198 INSERM U1095, Facultés de Médecine et de Pharmacie, Marseille, France.
authors.forename: Grégory
authors.initials: G
authors.lastname: Dubourg
authors.affiliation: The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel; Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel. Electronic address: paulm@post.tau.ac.il.
authors.forename: Mical
authors.initials: M
authors.lastname: Paul
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000008:administration & dosage / Q000494:pharmacology; D001987:Bronchiectasis / Q000188:drug therapy; D000069196:Gastrointestinal Microbiome / Q000187:drug effects; D007778:Lactobacillus; D008171:Lung Diseases / Q000188:drug therapy; D009765:Obesity / Q000382:microbiology; D015990:Placebo Effect; D056692:Prebiotics; D019936:Probiotics / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D058616:Synbiotics; D015430:Weight Gain; D015431:Weight Loss
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin; D056692:Prebiotics
keywords: Antibiotics; Meta-analysis; Prebiotics; Probiotics; Synbiotics; Systematic review; Weight