The Effect of Microbiome‐Modulating Therapeutics on Anthropometric and Hemodynamic Biomarkers in Metabolic Syndrome: A Systematic Review, Meta‐Analysis, and Meta‐Regression of Clinical Trials

Abstract

ABSTRACT Background Metabolic syndrome (MetS) is a prevalent cardiometabolic disorder characterized by central obesity, insulin resistance, dyslipidemia, and hypertension. Microbiome‐targeted therapies with probiotics, prebiotics, and synbiotics may improve outcomes by modulating metabolism, inflammation, and blood pressure. Methods We conducted a systematic review and meta‐analysis of randomized controlled trials (RCTs) in adults with MetS. Searches through April 2023 identified eligible RCTs, yielding 19 studies and 21 independent comparisons. Pooled mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random effects model. Subgroup analyses and meta‐regressions examined moderators and heterogeneity. Results A total of 19 studies comprising 21 trial comparisons were included. Microbiome‐modulating interventions were associated with modest reductions in waist circumference and body weight (BW), indicating improvements in central adiposity. In contrast, effects on body mass index (BMI) were limited, and no meaningful changes were observed in systolic or diastolic blood pressure (DBP). Subgroup and meta‐regression analyses suggested that higher microbial dose, longer intervention duration, and greater baseline adiposity were associated with more pronounced anthropometric responses. Moderate heterogeneity was observed across several outcomes. Conclusions Microbiome‐targeted therapies reduced waist circumference (WC) and BW in MetS but had no effect on BMI, systolic blood pressure (SBP), or DBP. These safe interventions may complement lifestyle strategies. Larger, standardized trials with microbiome profiling are needed to refine therapeutic use. These findings support a potential adjunctive role for microbiome‐targeted therapies in MetS, particularly for central adiposity, though standardized, longer duration trials with microbiome profiling are needed to clarify clinical utility.