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Efficacy and safety of probiotic/synbiotic supplementation for overweight or obese children: a systematic review and meta-analysis of randomized controlled trials

Pediatric Research (2025)Cite this article

Abstract

Background

The use of probiotics/synbiotic to assist in the treatment of overweight/obese children is currently a hot topic. However, the therapeutic effect is controversial. This meta-analysis assesses their effects and safety in overweight/obese children.

Methods

PubMed, Cochrane, Web of Science, and Embase were searched (2000- April 2024) for RCTs on probiotics/synbiotics in overweight/obese children. Primary outcomes included anthropometric measures, lipid profiles, insulin sensitivity, inflammatory markers, and liver enzymes. Result stability and heterogeneity sources were assessed by sensitivity and subgroup analyses. Subgroup analyses were conducted based on age, intervention time, complications and treatment methods. Review Manager 5.4.1 and STATA 15.0 were used to conduct the statistical analysis.

Results

A total of 16 studies were included (n = 763). L. acidophilus is the most commonly used. We found significant reductions in BMI-z, CRP and TNF-α. Synbiotics/probiotics are more effective when the treatment lasted for more than 3 months or when the patients was under 12 years old. All indicators lost significance in patients with NAFLD.

Conclusions

Probiotics/synbiotics significantly improved BMI-z, CRP, and TNF-α in overweight/obese children. Patients without complications under the age of 12 or those whose treatment lasts for more than 3 months will gain more benefits.

Impact

  • This study found that probiotics/synbiotics could significantly improve BMI-Zscore, CRP, and TNF-α in overweight/obese children.

  • This meta-analysis, incorporating the latest randomized controlled trials (RCTs), identified factors influencing probiotic/synbiotic efficacy through subgroup analysis: probiotic/synbiotic type, treatment duration, patient age, and the presence of complications.

  • This study provides further evidence supporting the effectiveness of probiotics/synbiotics in treating overweight/obese children.

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Fig. 1
Fig. 2: Profile of probiotic strains and prebiotics supplementation in the included studies.
Fig. 3
Fig. 4: Dosage and utilization profiles of probiotic strains.
Fig. 5: Forest plots of anthropometric indices.
Fig. 6: Forest plots of lipid profile.
Fig. 7: Forest plots of other relevant metabolic and inflammatory indicators.

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Data availability

The data used to support the findings of this study are included within the article.

References

  1. World Health Organization. Obesity and overweight [Internet]. Geneva: WHO; 2025 [cited 2025 Oct 13]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.

  2. Hampl, S. E., et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics 151, e2022060640 (2023).

    Article  PubMed  Google Scholar 

  3. Roy, S. M., et al. Infant BMI or weight-for-length and obesity risk in early childhood. Pediatrics 137, e20153492 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Skinner, A. C., et al. Prevalence of obesity and severe obesity in US children, 1999-2016. Pediatrics 141, e20173459 (2018).

    Article  PubMed  Google Scholar 

  5. Montero, D., Walther, G., Perez-Martin, A., Roche, E. & Vinet, A. Endothelial dysfunction, inflammation, and oxidative stress in obese children and adolescents: markers and effect of lifestyle intervention. Obes. Rev. 13, 441–455 (2012).

    Article  CAS  PubMed  Google Scholar 

  6. Aggarwal, B. & Jain, V. Obesity in children: definition, etiology and approach. Indian J. Pediatr. 85, 463–471, https://doi.org/10.1007/s12098-017-2531-x (2018).

    Article  PubMed  Google Scholar 

  7. anchez, M., Panahi, S. & Tremblay, A. Childhood obesity: a role for gut microbiota?. Int. J. Environ. Res. Public Health 12, 162–175 (2015).

    Article  Google Scholar 

  8. Backhed, F. et al. The gut microbiota as an environmental factor that regulates fat storage. Proc. Natl Acad. Sci. USA 101, 15718–15723 (2004).

    Article  PubMed  PubMed Central  Google Scholar 

  9. etraroli, M., Castellone, E., Patianna, V. & Esposito, S. Gut microbiota and obesity in adults and children: the state of the art. Front. Pediatr. 9, 657020 (2021).

    Article  Google Scholar 

  10. Subspecialty Group of Endocrinologic, Hereditary and Metabolic Diseases, the Society of Pediatrics, Chinese Medical Association; Subspecialty Group of Child Health Care, the Society of Pediatrics, Chinese Medical Association; Subspecialty Group of Clinical Nutrition, the Society of Pediarics, Chinese Medical Association; Editorial Board. Chin. J. Pediatr. Zhonghua Er Ke Za Zhi. 60, 507–515 (2022). https://doi.org/10.3760/cma.j.cn112140-20220112-00043

  11. Mead, E., et al. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database Syst. Rev. 6, CD012651 (2017).

    PubMed  Google Scholar 

  12. Abenavoli, L., et al. Gut microbiota and obesity: a role for probiotics. Nutrients 11, 2690 (2019).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Steer, T. et al. “Perspectives on the role of the human gut microbiota and its modulation by pro- and prebiotics”. Nutr. Res. Rev. 13, 229–254 (2000).

    Article  CAS  PubMed  Google Scholar 

  14. Gibson, G. R., et al. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nat. Rev. Gastroenterol. Hepatol. 14, 491–502 (2017).

    Article  PubMed  Google Scholar 

  15. Zhang, Q., Wu, Y. & Fei, X. Effect of probiotics on body weight and body-mass index: a systematic review and meta-analysis of randomized, controlled trials. Int. J. Food Sci. Nutr. 67, 571–580 (2015).

    Article  PubMed  Google Scholar 

  16. Derrien, M., Alvarez, A. S. & de Vos, W. M. The gut microbiota in the first decade of life. Trends Microbiol. 27, 997–1010 (2019).

    Article  CAS  PubMed  Google Scholar 

  17. Li, H. Y. et al. Effects and mechanisms of probiotics, prebiotics, synbiotics, and postbiotics on metabolic diseases targeting gut microbiota: a narrative review. Nutrients 13, 3211 (2021).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Krumbeck, J. A., et al. Probiotic Bifidobacterium strains and galactooligosaccharides improve intestinal barrier function in obese adults but show no synergism when used together as synbiotics. Microbiome 6, 121 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  19. Vallianou, N., Stratigou, T., Christodoulatos, G. S., Tsigalou, C. & Dalamaga, M. Probiotics, prebiotics, synbiotics, postbiotics, and obesity: current evidence, controversies, and perspectives. Curr. Obes. Rep. 9, 179–192 (2020).

    Article  PubMed  Google Scholar 

  20. Li, Y., Liu, T., Qin, L. & Wu, L. Effects of probiotic administration on overweight or obese children: a meta-analysis and systematic review. J. Transl. Med. 21, 525 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  21. Loy, M. H., Usseglio, J., Lasalandra, D. & Gold, M. A. Probiotic use in children and adolescents with overweight or obesity: a scoping review. Child Obes. 19, 145–159 (2023).

    Article  PubMed  Google Scholar 

  22. Page, M. J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372, n71 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wan, X., Wang, W., Liu, J. & Tong, T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med. Res. Method 14, 135 (2014).

    Article  Google Scholar 

  24. Luo, D., Wan, X., Liu, J. & Tong, T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat. Methods Med. Res. 27, 1785–1805 (2018).

    Article  PubMed  Google Scholar 

  25. Follmann, D., Elliott, P., Suh, I. & Cutler, J. Variance imputation for overviews of clinical trials with continuous response. J. Clin. Epidemiol. 45, 769–773 (1992).

    Article  CAS  PubMed  Google Scholar 

  26. Landis, J. R. & Koch, G. G. The measurement of observer agreement for categorical data. Biometrics 33, 159–174 (1977).

    Article  CAS  PubMed  Google Scholar 

  27. Higgins, J. P. & Thompson, S. G. Quantifying heterogeneity in a meta-analysis. Stat. Med. 21, 1539–1558 (2002).

    Article  PubMed  Google Scholar 

  28. Egger, M., Davey Smith, G., Schneider, M. & Minder, C. Bias in meta-analysis detected by a simple, graphical test. BMJ 315, 629–634 (1997).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Alisi, A. et al. “Randomised clinical trial: the beneficial effects of VSL#3 in obese children with non-alcoholic steatohepatitis. ”. Aliment. Pharmacol. Ther. 39.11, 1276–1285 (2014).

    Article  Google Scholar 

  30. Kilic Yildirim, G., Dinleyici, M., Vandenplas, Y. & Dinleyici, E. C. Effects of multispecies synbiotic supplementation on anthropometric measurements, glucose and lipid parameters in children with exogenous obesity: a randomized, double blind, placebo-controlled clinical trial (probesity-2 trial). Front. Nutr. 9, 898037 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  31. Atazadegan et al. “Effects of synbiotic supplementation on anthropometric indices and body composition in overweight or obese children and adolescents: a randomized, double-blind, placebo-controlled clinical trial”. World J. Pediatr. 19, 356–365 (2023).

    Article  CAS  PubMed  Google Scholar 

  32. Ipar, N. et al. Effects of synbiotic on anthropometry, lipid profile and oxidative stress in obese children. Benef. Microbes 6, 775–782 (2015).

    Article  CAS  PubMed  Google Scholar 

  33. Kelishadi, R., Farajian, S., Safavi, M., Mirlohi, M. & Hashemipour, M. A randomized triple-masked controlled trial on the effects of synbiotics on inflammation markers in overweight children. J. Pediatr. 90, 161–168 (2014).

    Article  Google Scholar 

  34. Kianifar et al. Effects of synbiotics on anthropometric indices of obesity in children: a randomized double-blind placebo-controlled pilot study. Top. Clin. Nutr. 33, 118–126 (2018).

    Article  Google Scholar 

  35. Famouri, F., Shariat, Z., Hashemipour, M., Keikha, M. & Kelishadi, R. Effects of probiotics on nonalcoholic fatty liver disease in obese children and adolescents. J. Pediatr. Gastroenterol. Nutr. 64, 413–417 (2017).

    Article  CAS  PubMed  Google Scholar 

  36. Goyal et al. “Probiotic and lifestyle modification in obese pediatrics with non-alcoholic fatty liver disease”. Indian J. Community Health 31, 427 (2019).

    Article  Google Scholar 

  37. Jones, R. B. et al. Probiotic supplementation increases obesity with no detectable effects on liver fat or gut microbiota in obese Hispanic adolescents: a 16-week, randomized, placebo-controlled trial. Pediatr. Obes. 13, 705–714 (2018).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Miccheli, A. et al. Urinary (1)H-NMR-based metabolic profiling of children with NAFLD undergoing VSL#3 treatment. Int. J. Obes. 39, 1118–1125 (2015).

    Article  CAS  Google Scholar 

  39. Rodrigo, T. et al. Effects of probiotics combined with dietary and lifestyle modification on clinical, biochemical, and radiological parameters in obese children with nonalcoholic fatty liver disease/nonalcoholic steatohepatitis: a randomized clinical trial. Clin. Exp. Pediatr. 65, 304–311 (2022).

    Article  CAS  PubMed  Google Scholar 

  40. Vajro, P. et al. Effects of Lactobacillus rhamnosus strain GG in pediatric obesity-related liver disease. J. Pediatr. Gastroenterol. Nutr. 52, 740–743 (2011).

    Article  PubMed  Google Scholar 

  41. Chen, A. C. et al. A multi-strain probiotic blend reshaped obesity-related gut dysbiosis and improved lipid metabolism in obese children. Front. Nutr. 9, 922993 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  42. Gøbel, R. J., Larsen, N., Jakobsen, M., Mølgaard, C. & Michaelsen, K. F. Probiotics to adolescents with obesity: effects on inflammation and metabolic syndrome. J. Pediatr. Gastroenterol. Nutr. 55, 673–678 (2012).

    Article  PubMed  Google Scholar 

  43. Sanchis-Chordà, J. et al. Bifidobacterium pseudocatenulatum CECT 7765 supplementation improves inflammatory status in insulin-resistant obese children. Eur. J. Nutr. 58, 2789–2800 (2019).

    PubMed  Google Scholar 

  44. Verma, A., Nelson, M. T., DePaolo, W. R., Hampe, C. & Roth, C. L. A randomized double-blind placebo controlled pilot study of probiotics in adolescents with severe obesity. J. Diabetes Metab. Disord. 20, 1289–1300 (2021).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Taylor, E. rinB. The complex role of adipokines in obesity, inflammation, and autoimmunity. Clin. Sci. 135, 731–752 (2021).

    Article  CAS  Google Scholar 

  46. Canfora, E. E., Jocken, J. W. & Blaak, E. E. Short-chain fatty acids in control of body weight and insulin sensitivity. Nat. Rev. Endocrinol. 11, 577–591 (2015).

    Article  CAS  PubMed  Google Scholar 

  47. Ciccia, F. et al. Dysbiosis and zonulin upregulation alter gut epithelial and vascular barriers in patients with ankylosing spondylitis. Ann. Rheum. Dis. 76, 1123–1132 (2017).

    Article  CAS  PubMed  Google Scholar 

  48. Kalliomäki, M., Collado, M. C., Salminen, S. & Isolauri, E. Early differences in fecal microbiota composition in children may predict overweight. Am. J. Clin. Nutr. 87, 534–538 (2008).

    Article  PubMed  Google Scholar 

  49. Roswall, J. et al. Developmental trajectory of the healthy human gut microbiota during the first 5 years of life. Cell Host Microbe 29, 765–776.e3 (2021).

    Article  CAS  PubMed  Google Scholar 

  50. Zhang, P. et al. Oxidative stress and diabetes: antioxidative strategies. Front. Med. 14, 583–600 (2020).

    Article  PubMed  Google Scholar 

  51. Rani, V., Deep, G., Singh, R. K., Palle, K. & Yadav, U. C. Oxidative stress and metabolic disorders: pathogenesis and therapeutic strategies. Life Sci. 148, 183–193 (2016).

    Article  CAS  PubMed  Google Scholar 

  52. Tilg, H., Adolph, T. E., Dudek, M. & Knolle, P. Non-alcoholic fatty liver disease: the interplay between metabolism, microbes and immunity. Nat. Metab. 3, 1596–1607 (2021).

    Article  CAS  PubMed  Google Scholar 

  53. Xiongzhong, R. & Yaxi, C. Metabolic inflammation and the development of non-alcoholic fatty liver disease [J]. Chin. J. Dig. 40, 581–584 (2020).

    Google Scholar 

  54. Zhang, M. M. et al. Use of pre-, pro-and synbiotics in patients with acute pancreatitis: a meta-analysis. World J. Gastroenterol. 16, 3970 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  55. Daniali, M., Nikfar, S. & Abdollahi, M. A brief overview on the use of probiotics to treat overweight and obese patients. Expert Rev. Endocrinol. Metab. 15, 1–4 (2020).

    Article  CAS  PubMed  Google Scholar 

  56. Gao, H. et al. The functional roles of Lactobacillus acidophilus in different physiological and pathological processes. J. Microbiol. Biotechnol. 32, 1226–1233 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Cheng, F. S., Pan, D., Chang, B., Jiang, M. & Sang, L. X. Probiotic mixture VSL#3: an overview of basic and clinical studies in chronic diseases [published correction appears in World J Clin Cases. 2021 Jul 16;9(20): 5752-5753.doi: 10.12998/wjcc. v9.i20.5752]. World J. Clin. Cases 8, 1361–1384 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  58. Sanders, M. E. et al. Safety assessment of probiotics for human use. Gut Microbes 1, 164–185 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  59. Bernardeau, M., Guguen, M. & Vernoux, J. P. Beneficial lactobacilli in food and feed: long-term use, biodiversity and proposals for specific and realistic safety assessments. FEMS Microbiol. Rev. 30, 487–513 (2006).

    Article  CAS  PubMed  Google Scholar 

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Funding

Research projects of the Guangdong Provincial Administration of Traditional Chinese Medicine (No.20231264).

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Authors and Affiliations

  1. Department of Pediatric, Guangzhou Medical University Guangzhou Guangdong, Guangzhou, China

    Meihao Ding, Jiaxin Zhuang & Liyu Chen

  2. Department of Children Health Care, Guangzhou Medical University Affliated Women and Children Medical Center, Guangzhou, China

    Dandan Hu & Jing Wang

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  1. Meihao Ding
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  2. Jiaxin Zhuang
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  3. Liyu Chen
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  4. Dandan Hu
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  5. Jing Wang
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Contributions

All authors contributed to the study conception and design. Meihao Ding: Conceptualization, Methodology, Software, Writing- Original draft, Data curation, Visualization were performed; Jiaxin Zhuang and Liyu Chen: Investigation, Writing - Original Draft, Writing - Reviewing and Editing were performed; Jing Wang and Dandan Hu: Conceptualization, Supervision, Project administration were performed. All authors read and approved the final manuscript.

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Correspondence to Dandan Hu or Jing Wang.

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Ding, M., Zhuang, J., Chen, L. et al. Efficacy and safety of probiotic/synbiotic supplementation for overweight or obese children: a systematic review and meta-analysis of randomized controlled trials. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04412-3

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