Meta-analysis of the effect of probiotics or synbiotics on the risk factors in patients with coronary artery disease

The prolonged impact of swapping non-fermented with fermented dairy products on cardiovascular disease: the ATTICA cohort study (2002-2022)

BACKGROUND/OBJECTIVES

Scientific evidence suggests that substituting non-fermented with fermented dairy products may confer cardiovascular health benefits. The role of fermented in relation to non-fermented dairy products on 20-year fatal/non-fatal cardiovascular disease (CVD) incidence was examined.

SUBJECTS/METHODS

In 2001-2002, n = 3042 free-of-CVD men and women from Attica, Greece, were recruited. Dietary assessment was based on a validated semi-quantitative food frequency questionnaire. CVD evaluation was performed in three follow-up time points at 5, 10 and 20 years, in n = 1988 participants (718 cases).

RESULTS

Participants reported >2 servings/day of fermented dairy products had 1.5 times lower risk to develop CVD compared with their lower level of consumption. Multi-adjusted analysis revealed similar cardioprotective properties per 1 serving increase in dairy consumption of fermented dairy products (Hazard Ratio (HR) = 0.82, 95% Confidence Interval (95%CI) (0.58, 0.95)) as well as when the ratios of fermented:total dairy products (0.90, (0.53, 0.95)) and fermented:non-fermented dairy products (0.74, (0.39, 0.92)) were ≥0.76 and ≥2.5, respectively. The associations were more evident in case of impaired inflammation status. Replacing 1 serving of non-fermented with 1 equivalent serving of fermented dairy products reduced CVD risk (0.74, (0.53, 0.92)). Substitution of low-fat with whole-fat yogurt increased CVD risk (1.35, (1.02, 1.58)). Replacing cheese (any kind) with low-fat yogurt reduced CVD risk (all HRs<1) while with whole-fat yogurt no significance was observed.

CONCLUSIONS

Shift of guidelines to a daily pattern of dairy intake yet with an inclination towards emphasizing the consumption of fermented products is recommended.

Association of probiotic supplementation and cardiovascular risk profiles of patients with coronary artery disease-a cross-sectional analysis of the NHANES database between 1999-2019

Background

Atherosclerotic cardiovascular disease (ASCVD) is a chronic inflammatory disease that leads to adverse events such as myocardial infarctions and stroke. Gut microbiome modulation is a promising target to reduce chronic inflammation and improve outcomes for patients with coronary artery disease (CAD). Risk profile patterns of CAD patients who target gut health with probiotics could provide insight into how gut modulation improves CAD clinical biomarkers. This study aims to evaluate the association between probiotic use and clinical markers of known atherosclerotic risk factors, in patients with CAD.

Methods

We conducted a cross-sectional large-database study using National Health and Nutrition Examination Survey (NHANES) data from years 1999-2020. The cohort included adults with at least a diagnosis of coronary heart disease, angina, and heart attack or two of the following: diabetes, high blood pressure, and high cholesterol. Analyses of clinical biomarkers compared probiotic to non-probiotic groups, between probiotic type groups, and between probiotic supplement strains.

Results

Our cohort included 14,992 survey responders. After weighting, this sample represented 46,217,980 US adults. There were 4,062,022 adults exposed to probiotics, 763,288 to probiotic supplements and 3,179,008 to probiotic foods. Probiotic exposure was associated with lower A1c (p < 0.001), lower triglycerides (p < 0.001), lower ASCVD risk score (p = 0.01) and higher HDL-C (p < 0.001). Probiotic supplement exposure was associated with lower LDL-C (p = 0.003) and total cholesterol (p = 0.047).

Conclusion

Our study reinforces the beneficial association between probiotic ingestion and cardiovascular health in patients with existing atherosclerotic disease. Further studies to better determine potential mechanistic connections between the gut microbiota on cardiovascular risk factors is warranted.

Protein-bound uremic toxins as therapeutic targets for cardiovascular, kidney, and metabolic disorders

Cardiovascular-kidney-metabolic (CKM) syndrome is a systemic clinical condition characterized by pathological and physiological interactions among metabolic abnormalities, chronic kidney disease, and cardiovascular diseases, leading to multi-organ dysfunction and a higher incidence of cardiovascular endpoints. Traditional approaches to managing CKM syndrome risk are inadequate in these patients, necessitating strategies targeting specific CKM syndrome risk factors. Increasing evidence suggests that addressing uremic toxins and/or pathways induced by uremic toxins may reduce CKM syndrome risk and treat the disease. This review explores the interactions among heart, kidney, and metabolic pathways in the context of uremic toxins and underscores the significant role of uremic toxins as potential therapeutic targets in the pathophysiology of these diseases. Strategies aimed at regulating these uremic toxins offer potential avenues for reversing and managing CKM syndrome, providing new insights for its clinical diagnosis and treatment.

Probiotic Supplementation during Pregnancy: Evaluating the Current Clinical Evidence against Gestational Diabetes Mellitus

BACKGROUND

Gestational diabetes mellitus (GDM) constitutes a common metabolic disorder that could lead to deleterious short- and long-term complications in both the mother and her infant. Probiotic supplementation seems to exert diverse, healthy effects by acting as a preventive agent against various human diseases, including GDM.

OBJECTIVE

The purpose of the current narrative review was to critically summarize and scrutinize the available clinical studies during the last 15 years (2008-2023) concerning the use of probiotic supplementation during pregnancy as a protecting agent against GDM.

METHODS

A thorough and in-depth search was performed in the most accurate scientific databases, e.g., PubMed., Scopus, Web of Science, and Google Scholar applying effective, and relevant keywords.

RESULTS

There are currently some clinical studies suggesting the potential beneficial impact of probiotic supplementation in the prevention and/or co-treatment of GDM. Nevertheless, there is a high heterogeneity amongst the available clinical studies concerning the dosage, the administration duration, the probiotic species types, the method designs and protocols, and the study populations.

CONCLUSION

Probiotic supplementation at conventional dosages and in combination with a balanced healthy diet, and lifestyle seems to reduce the the risk of developing GDM, while ameliorating the severity of its symptoms. Further clinical studies taking into account the above considerations should be performed to establish conclusive results, while the future meta-analyses should include studies with the feasibly lowest heterogeneity.

Neonatal Necrotizing Enterocolitis: An Update on Pathophysiology, Treatment, and Prevention

Necrotizing enterocolitis (NEC) is a life-threatening disease predominantly affecting premature and very low birth weight infants resulting in inflammation and necrosis of the small bowel and colon and potentially leading to sepsis, peritonitis, perforation, and death. Numerous research efforts have been made to better understand, treat, and prevent NEC. This review explores a variety of factors involved in the pathogenesis of NEC (prematurity, low birth weight, lack of human breast milk exposure, alterations to the microbiota, maternal and environmental factors, and intestinal ischemia) and reports treatment modalities surrounding NEC, including pain medications and common antibiotic combinations, the rationale for these combinations, and recent antibiotic stewardship approaches surrounding NEC treatment. This review also highlights the effect of early antibiotic exposure, infections, proton pump inhibitors (PPIs), and H2 receptor antagonists on the microbiota and how these risk factors can increase the chances of NEC. Finally, modern prevention strategies including the use of human breast milk and standardized feeding regimens are discussed, as well as promising new preventative and treatment options for NEC including probiotics and stem cell therapy.

Probiotics Supplementation during Pregnancy: Can They Exert Potential Beneficial Effects against Adverse Pregnancy Outcomes beyond Gestational Diabetes Mellitus?

BACKGROUND

Probiotics, as supplements or food ingredients, are considered to exert promising healthy effects when administered in adequate quantity. Probiotics' healthy effects are related with the prevention of many diseases, as well as decreasing symptom severity. Currently, the most available data concerning their potential health effects are associated with metabolic disorders, including gestational diabetes mellitus. There is also clinical evidence supporting that they may exert beneficial effects against diverse adverse pregnancy outcomes. The purpose of the current narrative study is to extensively review and analyze the current existing clinical studies concerning the probable positive impacts of probiotics supplementation during pregnancy as a protective agent against adverse pregnancy outcomes beyond gestational diabetes mellitus.

METHODS

a comprehensive and thorough literature search was conducted in the most precise scientific databases, such as PubMed, Scopus, and Web of Sciences, utilizing efficient, representative, and appropriate keywords.

RESULTS

in the last few years, recent research has been conducted concerning the potential beneficial effects against several adverse pregnancy outcomes such as lipid metabolism dysregulation, gestational hypertensive disorders, preterm birth, excessive gestational weight gain, caesarean risk section, vaginal microbiota impairment, mental health disturbances, and others.

CONCLUSION

up to the present day, there is only preliminary clinical data and not conclusive results for probiotics' healthy effects during pregnancy, and it remains questionable whether they could be used as supplementary treatment against adverse pregnancy outcomes beyond gestational diabetes mellitus.

Role of probiotics in managing various human diseases, from oral pathology to cancer and gastrointestinal diseases

The imbalance of microbial composition and diversity in favor of pathogenic microorganisms combined with a loss of beneficial gut microbiota taxa results from factors such as age, diet, antimicrobial administration for different infections, other underlying medical conditions, etc. Probiotics are known for their capacity to improve health by stimulating the indigenous gut microbiota, enhancing host immunity resistance to infection, helping digestion, and carrying out various other functions. Concurrently, the metabolites produced by these microorganisms, termed postbiotics, which include compounds like bacteriocins, lactic acid, and hydrogen peroxide, contribute to inhibiting a wide range of pathogenic bacteria. This review presents an update on using probiotics in managing and treating various human diseases, including complications that may emerge during or after a COVID-19 infection.