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Synbiotic Efficacy as Therapeutic Approach in Human Disease: A Review

Beauty Akter, Rabeta Mohd Salleh and Mohamad Hafizi Abu Bakar

Pertanika Journal of Tropical Agricultural Science, Volume 44, Issue 1, February 2021

DOI: https://doi.org/10.47836/pjtas.44.1.04

Keywords: Diabetes, obesity, prebiotic, probiotic, synbiotic

Published on: 24 Febuary 2021

In combatting the increase in healthcare costs, at present, one of the preventive approaches to medicine has been developed with the upliftment of new synbiotic products. Synbiotic is the synergistic effect of probiotics and prebiotics which exert multiple beneficial effects and have been increasingly used in preventing or treating human diseases since the last ten years. Several trials have reported that synbiotic therapy could help in the treatment of human disease prevention. PubMed, Science Direct, and Google Scholar were searched by keyword ‘prebiotic’, ‘probiotic’, and ‘synbiotic’ for relevant literature from 2000 to 2020. A total of 58 articles were selected and revised. This paper evaluates the effect of synbiotic supplementation on different diseases, for instance, obesity, insulin resistance syndrome, diabetes, and non-alcoholic fatty liver disease. The progressive knowledge on the outcome of synbiotic supplementation on health, recent trends and developments in this field are summarised. However, further research is required to understand the mechanism of how synbiotics affect in different diseases.

  • Anhê, F. F., Varin, T. V., Le Barz, M., Desjardins, Y., Levy, E., Roy, D., & Marette, A. (2015). Gut microbiota dysbiosis in obesity-linked metabolic diseases and prebiotic potential of polyphenol-rich extracts. Current Obesity Reports, 4(4), 389–400. https://doi.org/10.1007/s13679-015-0172-9

  • Asemi, Z., Khorrami-Rad, A., Alizadeh, S. A., Shakeri, H., & Esmaillzadeh, A. (2014). Effects of synbiotic food consumption on metabolic status of diabetic patients: A double-blind randomized cross-over controlled clinical trial. Clinical Nutrition, 33(2), 198-203. https://doi.org/10.1016/j.clnu.2013.05.015

  • Bakhshimoghaddam, F., Shateri, K., Sina, M., Hashemian, M. S., & Alizadeh, M. (2018). Daily consumption of synbiotic yogurt decreases liver steatosis in patients with non-alcoholic fatty liver disease: A randomized controlled clinical trial. The Journal of Nutrition, 148 (8), 1276-1284. https://doi.org/10.1093/jn/nxy088

  • Boulangé, C. L., Neves, A. L., Chilloux, J., Nicholson, J. K., & Dumas, M. (2016). Impact of the gut microbiota on inflammation, obesity, and metabolic disease. Genome Medicine, 8(1), 42. https://doi.org/10.1186/s13073-016-0303-2

  • Çakır, M., Aksel İşbilen, A., Eyüpoğlu, İ., Sağ, E., Örem, A., Mazlum Şen, T., Kaklıkkaya, N., & Kaya, G. (2017). Effects of long-term synbiotic supplementation in addition to lifestyle changes in children with obesity-related non-alcoholic fatty liver disease. Turkish Journal of Gastroenterology, 28(5), 377–383. https://doi.org/10.5152/tjg.2017.17084

  • Capitán-Cañadas, F., Ortega-González, M., Guadix, E., Zarzuelo, A., Suárez, M. D., de Medina, F. S., & Martínez-Augustin, O. (2014). Prebiotic oligosaccharides directly modulate proinflammatory cytokine production in monocytes via activation of TLR4. Molecular Nutrition Food Research, 58(5), 1098-1110. https://doi.org/10.1002/mnfr.201300497

  • Chan, C. K. Y., Tao, J., Chan, O. S., Li, H. B., & Pang, H. (2020). Preventing respiratory tract infections by synbiotic interventions: A systematic review and meta-analysis of randomized controlled trials. Advances in Nutrition, 11(4), 979-988. https://doi.org/10.1093/advances/nmaa003

  • Chillarón, J. J., Roux, J. A. F., Benaiges, D., & Pedro-Botet, J. (2014). Subclinical cardiovascular disease in type 2 diabetes mellitus: To screen or not to screen. World Journal of Clinical Cases, 2(9), 415–421. https://doi.org/10.12998/wjcc.v2.i9.415

  • Covasa, M., Stephens, R. W., Toderean, R., & Cobuz, C. (2019). Intestinal Sensing by gut microbiota: Targeting gut peptides. Frontiers in Endocrinology, 10, 82. https://doi.org/10.3389/fendo.2019.00082

  • Dehghani, H., Heidari, F., Mozaffari-Khosravi, H., Nouri-Majelan, N., & Dehghani, A. (2016). Synbiotic supplementations for azotemia in patients with chronic kidney disease: a randomized controlled trial. Iranian Journal of Kidney Diseases, 10(6), 351-357.

  • DiRienz, D. B. (2014). Effect of probiotics on biomarkers of cardiovascular disease: Implications for heart-healthy diets. Nutrition Reviews, 72(1), 18–29. https://doi.org/10.1111/nure.12084

  • dos Santos, A. C., Ribeiro, D. A., da Cruz Ferreira, J. A., Aguiar, O., Waitzberg, D. L., & Alves, C. C. (2019). Inflammatory gene expression analysis after prebiotic, probiotic and synbiotic supplementation in experimental non-alcoholic fatty liver disease. Nutrition and Food Science, 49(1), 75-84. https://doi.org/10.1108/NFS-04-2018-0119

  • Eslamparast, T., Poustchi, H., Zamani, F., Sharafkhah, M., Malekzadeh, R., & Hekmatdoost, A. (2014a). Synbiotic supplementation in non-alcoholic fatty liver disease: A randomized, double-blind, placebo-controlled pilot study. The American Journal of Clinical Nutrition, 99(3), 535-42. https://doi.org/10.3945/ajcn.113.068890

  • Eslamparast, T., Zamani, F., Hekmatdoost, A., Sharafkhah, M., Eghtesad, S., Malekzadeh, R., & Poustchi, H. (2014b). Effects of synbiotic supplementation on insulin resistance in subjects with the metabolic syndrome: A randomised, double-blind, placebo-controlled pilot study. British Journal of Nutrition, 112(3), 438–445. https://doi.org/10.1017/S0007114514000919

  • Farrag, A., Bakhoum, S., Salem, M. A., El-Faramawy, A., & Gergis, E. (2013). The association between extracoronary calcification and coronary artery disease in patients with type 2 diabetes mellitus. Heart Vessels, 28(1), 12–18. https://doi.org/10.1007/s00380-011-0205-6

  • Farrokhian, A., Raygan, F., Soltani, A., Tajabadi-Ebrahimi, M., Esfahani, M. S., Karami, A. A., & Asemi, Z. (2019). The effects of synbiotic supplementation on carotid intima-media thickness, biomarkers of inflammation and oxidative stress in people with overweight, diabetes and coronary heart disease: A randomized, double-blind, placebo-controlled trial. Probiotics and Antimicrobial Proteins, 11(1), 133-142. https://doi.org/10.1007/s12602-017-9343-1

  • Ferrarese, R., Ceresola, E., Preti, A., & Canducci, F. (2018). Probiotics, prebiotics and synbiotics for weight loss and metabolic syndrome in the microbiome era. European Review for Medical and Pharmacological Sciences, 22(21), 7588–7605. https://doi.org/10.26355/eurrev_201811_16301

  • Frece, J., Kos, B., Svetec, I. K., Zgaga, Z., Beganović, J., Lebos, A., & Susković, J. (2009). Synbiotic effect of Lactobacillus helveticus M92 and prebiotics on the intestinal microflora and immune system of mice. Journal of Dairy Research, 76(1), 98-104. https://doi.org/10.1017/S0022029908003737

  • Gaede, P., Vedel, P., Larsen, N., Jensen, G. V. H., Parving, H., & Pedersen, O. (2003). Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. The New England Journal of Medicine, 348(5), 383-393. https://doi.org/10.1056/NEJMoa021778

  • Gurry, T. (2017). Synbiotic approaches to human health and well-being. Microbial Biotechnology, 10(5), 1070–1073. https://doi.org/10.1111/1751-7915.12789

  • Han, J.-L., & Lin, H.-L. (2014). Intestinal microbiota and type 2 diabetes: From mechanism insights to therapeutic perspective. World Journal of Gastroenterology, 20(47), 17737–17745. https://doi.org/10.3748/wjg.v20.i47.17737

  • Heiss, C. N., & Olofsson, L. E. (2018). Gut microbiota-dependent modulation of energy metabolism. Journal of Innate Immunity, 10(3), 163–171. https://doi.org/10.1159/000481519

  • Hernandez-Rodas, M. C., Valenzuela, R., & Videla, L. A. (2015). Relevant aspects of nutritional and dietary interventions in non-alcoholic fatty liver disease. International Journal of Molecular Science, 16(10), 25168-25198. https://doi.org/10.3390/ijms161025168

  • Hinai, E. A. A., Kullamethee, P., Rowland, I. R., Swann, J., Walton, G. E., & Commane, D. M. (2019). Modelling the role of microbial ρ-cresol in colorectal genotoxicity. Gut Microbes, 10(3), 398–411. https://doi.org/10.1080/19490976.2018.1534514

  • Hong, H. R., Ha, C. D., Kong, J. Y., Lee, S. H., Song, M. G., & Kang, H. S. (2014). Roles of physical activity and cardiorespiratory fitness on sex difference in insulin resistance in late elementary years. Journal of Exercise Nutrition and Biochemistry, 18(4), 361–369. https://doi.org/10.5717/jenb.2014.18.4.361

  • Ipar, N., Aydogdu, S. D., Yildirim, G. K., Inal, M., Gies, I., Vandenplas, Y., & Dinleyici, E.C. (2015). Effects of synbiotic on anthropometry, lipid profile and oxidative stress in obese children. Beneficial Microbes, 6(6), 775–781. https://doi.org/10.3920/BM2015.0011

  • Katsiki, N., Mikhailidis, D. P., & Mantzoros, C. S. (2016). Non-alcoholic fatty liver disease and dyslipidemia: An update. Metabolism, 65(8), 1109-23. https://doi.org/10.1016/j.metabol.2016.05.003

  • Kellow, N. J., Coughlan, M. T., Savige, G. S., & Reid, C. M. (2014). Effect of dietary prebiotic supplementation on advanced glycation, insulin resistance and inflammatory biomarkers in adults with pre-diabetes: A study protocol for a double-blind placebo-controlled randomised crossover clinical trial. BMC Endocrine Disorders, 14(1), 55. https://doi.org/10.1186/1472-6823-14-55

  • Kocełak, P., Olszanecka-Glinianowicz, M., & Chudek, J. (2012). Fibroblast growth factor 23 – Structure, function and role in kidney diseases. Advances in Clinical and Experimental Medicine, 21(3), 391–401.

  • Larsen, N., Vogensen, F. K., van den Berg, F. W., Nielsen, D. S., Andreasen, A. S., Pedersen, B. K., Al-Soud, W. A., Sørensen, S. J., Hansen, L. H., & Jakobsen, M. (2010). Gut microbiota in human adults with type 2 diabetes differs from non-diabetic adults. PLOS One, 5(2), e9085. https://doi.org/10.1371/journal.pone.0009085

  • Malaguarnera, M., Vacante, M., Antic, T., Giordano, M., Chisari, G., Acquaviva, R., Mastrojeni, S., Malaguarnera, G., Mistretta, A., Volti, G. L. & Galvan, F. (2012). Bifidobacterium longum with fructo-oligosaccharides in patients with non-alcoholic steatohepatitis. Digestive Diseases and Sciences, 57(2), 545–553. https://doi.org/10.1007/s10620-011-1887-4

  • Markowiak, P. & Śliżewska, K. (2017). Effects of probiotics, prebiotics, and synbiotics on human health. Nutrients, 9(9), 1021. https://doi.org/10.3390/nu9091021

  • Martinez, K. B., Leone, V., & Chang, E. B. (2017). Western diets, gut dysbiosis, and metabolic diseases: Are they linked?. Gut Microbes, 8(2), 130–142. https://doi.org/10.1080/19490976.2016.1270811

  • Mehal, W. Z. (2013). The Gordian knot of dysbiosis, obesity and NAFLD. Nature Reviews Gastroenterology and Hepatology, 10(11), 637-644. https://doi.org/10.1038/nrgastro.2013.146

  • Moroti, C., Magri, L. F. S., Costa, M. d. R., Cavallini, D. C. U., & Sivieri, K. (2012). Effect of the consumption of a new symbiotic shake on glycemia and cholesterol levels in elderly people with type 2 diabetes mellitus. Lipids in Health and Disease, 11(1), 29. https://doi.org/10.1186/1476-511X-11-29

  • Nakabayashi, I., Nakamura, M., Kawakami, K., Ohta, T., Kato, I., Uchida, K., & Yoshida, M. (2011). Effects of synbiotic treatment on serum level of ρ-cresol in haemodialysis patients: A preliminary study. Nephrology Dialysis Transplantation, 26(3), 1094–1098. https://doi.org/10.1093/ndt/gfq624

  • Niwa, T. (2011). Role of indoxyl sulfate in the progression of chronic kidney disease and cardiovascular disease: Experimental and clinical effects of oral sorbent AST-120. Therapeutic Apheresis and Dialysis, 15(2), 120–124. https://doi.org/10.1111/j.1744-9987.2010.00882.x

  • Noakes, M., Keogh, J. B., Foster, P. R., & Clifton, P. M. (2005). Effect of an energy-restricted, high-protein, low-fat diet relative to a conventional high-carbohydrate, low-fat diet on weight loss, body composition, nutritional status, and markers of cardiovascular health in obese women. American Journal of Clinical Nutrition, 81(6), 1298-306. https://doi.org/10.1093/ajcn/81.6.1298

  • Plaza-Diaz, J., Ruiz-Ojeda, F. J., Gil-Campos, M. & Gil, A. (2019). Mechanisms of action of probiotics. Advances in Nutrition, 10(1), S49–S66. https://doi.org/10.1093/advances/nmy063

  • Quigley, E. M., & Monsour, H. P. (2015). The gut microbiota and non-alcoholic fatty liver disease. Seminars in Liver Disease, 35(3), 262-269. https://doi.org/10.1055/s-0035-1562946

  • Rabiei, S., & Hekmatdoost, A. (2019). New therapeutic agents to treat obesity and its related disorders: Prebiotic, probiotic and synbiotic supplementation. International Journal of Food and Nutritional Science, 6(1), 43-53.

  • Raso, G. M., Simeoli, R., Iacono, A., Santoro, A., Amero, P., Paciello, O., Russo, R., D’Agostino, G., Di Costanzo, M., Canani, R. B., Calignano, A., & Meli, R. (2014). Effects of a Lactobacillus paracasei B21060 based synbiotic on steatosis, insulin signaling and toll-like receptor expression in rats fed a high-fat diet. The Journal of Nutritional Biochemistry, 25(1), 81–90. https://doi.org/10.1016/j.jnutbio.2013.09.006

  • Russell, W. R., Gratz, S. W., Duncan, S. H., Holtrop, G., Ince, J., Scobbie, L., Duncan, G., Johnstone, A. M., Lobley, G. E., Wallace, R. J., Duthie, G. G., & Flint, H. J. (2011). High-protein, reduced-carbohydrate weight-loss diets promote metabolite profiles likely to be detrimental to colonic health. The American Journal of Clinical Nutrition, 93(5), 1062–1072. https://doi.org/10.3945/ajcn.110.002188

  • Sáez-Lara, M. J., Robles-Sanchez, C., Ruiz-Ojeda, F. J., Plaza-Diaz, J., & Gil, A. (2016). Effects of probiotics and synbiotics on obesity, insulin resistance syndrome, type 2 diabetes and non-alcoholic fatty liver disease: A review of human clinical trials. International Journal of Molecular Science, 17(6), 928. https://doi.org/10.3390/ijms17060928

  • Sanchez, M., Darimont, C., Drapeau, V., Emady-Azar, S., Lepage, M., Rezzonico, E., Ngom-Bru, C., Berger, B., Philippe, L., Ammon-Zuffrey, C., Leone, P., Chevrier, G., St-Amand, E., Marette, A., Doré, J., & Tremblay, A. (2014). Effect of Lactobacillus rhamnosus CGMCC1.3724 supplementation on weight loss and maintenance in obese men and women. The British Journal of Nutrition, 111(8), 1507–1519. https://doi.org/10.1017/S0007114513003875

  • Sergeev, I. N., Aljutaily, T., Walton, G., & Huarte, E. (2020). Effects of synbiotic supplement on human gut microbiota, body composition and weight loss in obesity. Nutrients, 12(1), 222. https://doi.org/10.3390/nu12010222

  • Singh, K., Kallali, B., Kumar, A., & Thaker, V. (2011). Probiotics: A review. Asian Pacific Journal of Tropical Biomedicine, 1(2), S287-S290. https://doi.org/10.1016/S2221-1691(11)60174-3

  • Taghizadeh, M., Hashemi, T., Shakeri, H., Abedi, F., Sabihi, S., Alizadeh, S., & Asemi, Z. (2014). Synbiotic food consumption reduces levels of triacylglycerols and VLDL, but not cholesterol, LDL, or HDL in plasma from pregnant women. Lipids, 49(2), 155–161. https://doi.org/10.1007/s11745-013-3867-2

  • Tajabadi-Ebrahimi, M., Sharifi, N., Farrokhian, A., Raygan, F., Karamali, F., Razzaghi, R., Taheri, S., & Asemi, Z. (2017). A randomized controlled clinical trial investigating the effect of synbiotic administration on markers of insulin metabolism and lipid profiles in overweight type 2 diabetic patients with coronary heart disease. Experimental and Clinical Endocrinology and Diabetes, 125(1), 21–27. https://doi.org/10.1055/s-0042-105441

  • Tajadadi-Ebrahimi, M., Bahmani, F., Shakeri, H., Hadaegh, H., Hijijafari, M., Abedi, F., & Asemi, Z. (2014). Effects of daily consumption of synbiotic bread on insulin metabolism and serum high-sensitivity C-reactive protein among diabetic patients: A double-blind, randomized, controlled clinical trial. Annals of Nutrition and Metabolism, 65(1), 34–41. https://doi.org/10.1159/000365153

  • Turnbaugh, P. J., Hamady, M., Yatsunenko, T., Cantarel, B. L., Duncan, A., Ley, R. E., Sogin, M. L., Jones, W. J., Roe, B. A., Affourtit, J. P., Egholm, M., Henrissat, B., Heath, A. C., Knight, R., & Gordon, J. I. (2009). A core gut microbiome in obese and lean twins. Nature, 457(7228), 480–484. https://doi.org/10.1038/nature07540

  • Vajro, P., Lenta, S., Socha, P., Dhawan, A., McKiernan, P., Baumann, U., Durmaz, O., Lacaille, F., McLin, V., & Nobili, V. (2012). Diagnosis of non-alcoholic fatty liver disease in children and adolescents: Position paper of the ESPGHAN hepatology committee. Journal of Pediatric Gastroenterology and Nutrition, 54(5), 700–713. https://doi.org/10.1097/MPG.0b013e318252a13f

  • Vaziri, N. D. (2016). Effect of synbiotic therapy on gut–derived uremic toxins and the intestinal microbiome in patients with CKD. Clinical Journal of the American Society of Nephrology, 11(2), 199–201. https://doi.org/10.2215/CJN.13631215

  • World Health Organization. (2018). Diseases of the respiratory system. https://www.who.int/classifications/icd/revision/en/

  • Yang, T., Richards, E. M., Pepine, C. J. & Raizada, M. K. (2018). The gut microbiota and the brain-gut-kidney axis in hypertension and chronic kidney disease. Nature Reviews Nephrology, 14(7), 442–456. https://doi.org/10.1038/s41581-018-0018-2

  • Yao, C. K., Muir, J. G., & Gibson, P. R. (2016). Review article: Insights into colonic protein fermentation, its modulation and potential health implications. Alimentary Pharmacology and Therapeutics, 43(2), 181–196. https://doi.org/10.1111/apt.13456

  • Yoo, J. Y., & Kim, S. S. (2016). Probiotics and prebiotics: Present status and future perspectives on metabolic disorders. Nutrients, 8(3), 173. https://doi.org/10.3390/nu8030173

  • Zarrati M., Salehi E., Nourijelyani K., Mofid V., Zadeh M. J. H., Najafi F., Ghaflati Z., Bidad K., Chamari M., Karimi M., & Shidfar F. (2014). Effects of probiotic yogurt on fat distribution and gene expression of proinflammatory factors in peripheral blood mononuclear cells in overweight and obese people with or without weight-loss diet. Journal of the American College of Nutrition, 33(6), 417–425. https://doi.org/10.1080/07315724.2013.874937

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e-ISSN 2231-8542

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JTAS-2059-2020

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