Najmeh Zare, Samuel J Burden, Marianne Beach, Alexander Jones
The pattern of responses to microbiome-targeted interventions was consistent with greater effects on early biological components of paediatric cardiometabolic disease, including adiposity, hepatic dysfunction and systemic inflammation. Evidence for downstream cardiometabolic risk factor modification was limited. Longer, targeted trials are needed to confirm clinical relevance.
BACKGROUND: Cardiometabolic disease develops across the life course, making childhood critical for cardiovascular prevention. Although microbiome-targeted interventions improve some cardiometabolic outcomes in adults, whether similar interventions influence cardiometabolic risk during childhood remains uncertain. This systematic review and meta-analysis evaluated microbiome-targeted interventions for cardiometabolic outcomes in children and adolescents.
METHODS: A systematic search of PubMed, MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and CINAHL was conducted. Randomised controlled trials assessing dietary interventions, fecal microbiome transfer, prebiotics, probiotics, or synbiotics in participants aged 1 month-19 years were included. Cardiometabolic outcomes were grouped as: adiposity, lipids, liver function, inflammation, glycaemic regulation, and blood pressure. Inverse-variance weighted random-effects meta-analysis with restricted maximum likelihood produced pooled estimates. Sources of heterogeneity (age, sex, and intervention duration) were assessed by meta-regression (PROSPERO CRD42022321814).
RESULTS: Twenty-one of 28 included studies were meta-analysed. Compared with placebo, body mass index z-score (Hedges' g=-0.36, 95% CI -0.64 to -0.08) and C-reactive protein (g=-0.68, -1.27 to -0.09) decreased following microbiome-targeted interventions, with a borderline reduction of alanine aminotransferase (g=-0.33, -0.66 to 0.00); body fat percentage, lipid outcomes, insulin resistance, and blood pressure did not change significantly. In a multivariate analysis across pre-specified cardiometabolic markers, a small overall reduction was observed (g=-0.21, -0.33 to -0.10).
CONCLUSIONS: The pattern of responses to microbiome-targeted interventions was consistent with greater effects on early biological components of paediatric cardiometabolic disease, including adiposity, hepatic dysfunction and systemic inflammation. Evidence for downstream cardiometabolic risk factor modification was limited. Longer, targeted trials are needed to confirm clinical relevance.