|Year : 2016 | Volume
| Issue : 4 | Page : 280-286
Potential of probiotics in hypercholesterolemia: A meta-analysis
Smriti Sharma1, Anura Vishwanathan Kurpad2, Seema Puri3
1 Senior Research Fellow, Food and Nutrition, Department of Home Science, University of Delhi, New Delhi, India
2 Professor and Head, Department of Physiology, St. John's Medical College, Bengaluru, Karnataka, India
3 Associate Professor, Department of Nutrition, Institute of Home Economics, University of Delhi, New Delhi, India
|Date of Web Publication||15-Dec-2016|
Institute of Home Economics, University of Delhi, F-4 Hauz Khas Enclave, New Delhi - 110 016
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Human studies on the effects of probiotics on lowering blood cholesterol levels have not yielded conclusive results. A meta-analysis of randomized controlled trials evaluating the effect of probiotics on lipid profile was conducted. Articles were reviewed systematically from web search bases; PubMed, Cochrane Clinical Trial Registry. Those studies which were meeting the inclusion criteria-providing matching placebo, at least single blind for probiotics and placebo, providing mean and standard deviations and not involving the use of probiotics were selected. 14 studies from 12 randomized controlled trials were analyzed providing information of 606 normo/hypercholesterolemic patients using Review Manager 5.3 (The Cochrane Collaboration, Oxford, UK). The pooled mean net change for total cholesterol (TC) is −8.40 mg/dl (−13.63, −3.61), for low-density lipoprotein (LDL) is −6.63 mg/dl (−10.63, −2.63), for high-density-lipoprotein-cholesterol is 0.59 mg/dl (−0.92, 2.09), and for triglycerides is −1.32 mg/dl (−6.49, 3.85). The findings of the analysis conclude that probiotics supplementation does lower serum TC and LDL-cholesterol levels significantly and hence a reduction in the risk factor of developing coronary heart disease.
Keywords: Coronary heart disease, functional foods, hypercholesterolemia, probiotics
|How to cite this article:|
Sharma S, Kurpad AV, Puri S. Potential of probiotics in hypercholesterolemia: A meta-analysis. Indian J Public Health 2016;60:280-6
|How to cite this URL:|
Sharma S, Kurpad AV, Puri S. Potential of probiotics in hypercholesterolemia: A meta-analysis. Indian J Public Health [serial online] 2016 [cited 2019 Aug 20];60:280-6. Available from: http://www.ijph.in/text.asp?2016/60/4/280/195859
| Introduction|| |
It is well known higher levels of serum cholesterol are generally considered to be a risk factor for coronary heart disease (CHD). Results from several epidemiological and clinical studies indicate a positive correlation between elevated total serum cholesterol levels, mainly reflecting the low-density lipoprotein (LDL)-cholesterol fraction and risk of emergence of CHD. The WHO has predicted that by 2030, CHD or diseases of heart will remain the leading cause of death, affecting approximately 23.6 million people worldwide. South Asians around the globe have the highest rates of coronary artery disease.
Currently, there is extensive interest in the dietary management of serum cholesterol and triglyceride (TG) levels. This is largely driven by the large numbers of individuals affected, the expense of drug therapy; statins, fibrates, niacin, cholesterol absorption inhibitors, and bile acid sequestrants, and unwanted side effects of such treatments which have concerned long-term use. For this reason, a number of nonpharmacological approaches such as lifestyle modification, inclusion of potential cholesterol-lowering products such as plant stanols, soy, cinnamon, and also probiotic strains resulting in serum cholesterol reduction are continuously being developed and tested. Probiotics are defined as “living microbial supplements that beneficially affect the host animals by improving its intestinal microbial balances” or as live microorganisms that when administered in adequate amounts, confer a health benefit on the host.
The virtues of probiotics are already well recognized for general gut health and immunity; various studies have indicated that probiotics may alleviate lactose intolerance, have a positive influence on the intestinal flora of the host, reduce inflammatory or allergic reactions, possess anti-colon cancer effects, antihypertensive effects, and reduce clinical manifestations of atopic dermatitis, Crohn's disease, diarrhea, constipation, candidiasis, and urinary tract infections.,, More recently, probiotics have also been studied for their cholesterol-lowering effects.,, A number of animal studies using a variety of strains have demonstrated this effect.,,,,, Human studies, on the other hand, have yielded inconsistent results with some showing positive significant effects while others with no effects.,,,, With more such conflicting results, it was considered worthwhile to conduct a meta-analysis of randomized controlled trials evaluating the effect of probiotics on serum lipid levels.
| Materials and Methods|| |
PubMed was searched through for randomized controlled trials for evaluating the effect of probiotics on lipid profile using keywords - (cholesterol OR lipid profile OR HDL-cholesterol OR LDL-cholesterol OR TGs) AND (probiotics OR fermented milk products). Those studies were selected which met inclusion criteria: (1) randomized controlled trials which were at least single blinded for participants, both probiotics and placebo; (2) study designs which used a matched control group, i.e., the use of yogurt against yogurt and capsules against capsule; (3) studies which provided values of mean and standard deviation for total cholesterol (TC), LDL-cholesterol, high-density lipoprotein (HDL)-cholesterol and TG levels for both intervention and control groups; (4) use of prebiotics/plant stanols/nutrient apart from probiotics; and (5) publications in English language.
Data abstraction was performed by the author (Smriti Sharma). As presented in [Table 1], information related to articles such as first authors' name, year of publication, probiotics type used placebo type, sample size, study design, study duration, dosage, inclusion criteria, age, sex, sample size, baseline values of serum TC; LDL-cholesterol, HDL-cholesterol, and TGs levels separately for intervention and control arm were abstracted from the articles reviewed. We assessed the methodological quality of the included clinical trials using the modified Jadad scale. The modified Jadad scale scores range from 1 (very low) to 5 (very high). The 5-point quality scale assigns points for randomization (described as randomized, 1 point; described appropriate randomization method, additional point), double blinding (described as double blind, 1 point; described appropriate blinding method, additional point), and follow-up (stated the number and reasons for withdrawal in each group, 1 point) in the report of each trial. All trials were classified into two groups based on scores of <3 as low-quality or ≥3 as high-quality studies.
For the meta-analysis, changes in mean and standard deviation of lipid parameters (TC, LDL-cholesterol, HDL-cholesterol, and TGs) were of interest. The values were therefore appropriately modified from mmol/L to mg/dl, and standard errors were converted to standard deviation. The conversion factor used was 1 mg/dl = 0.0259 mmol/L for TC, LDL-cholesterol and HDL-cholesterol and 1 mg/dl = 0.0113 mmol/L for TG values wherever applicable.
As most articles provide the mean and standard deviations at baseline and endpoint, the net change was calculated. For parallel trials, mean net changes for the outcomes listed above were calculated as the difference (probiotic diet minus control diet) of the changes (baseline minus endpoint) in mean values. For crossover trials, mean net changes for the outcomes were calculated as the difference (probiotic diet minus control diet) in values at the end of the intervention and control phases. For computing the change in standard deviations for one taken at baseline and at the end of treatment, the variance of the difference expressed as:
Var (Δ) =2 σ (1 − r).
was used where r is the observed tracking correlation between cholesterol measures at baseline and follow-up., The analysis was conducted using Review Manager 5.3 (The Cochrane Collaboration, Oxford, UK). Heterogeneity between studies was assessed using the Chi-square test and I statistic with values ranging from 0% to 100%. Statistical significance for the test of heterogeneity was set at 0.05. If significant heterogeneity existed, it would have been inappropriate to combine the data for further analysis using a fixed-effects model. In such cases, the random-effect model was used for calculation.
To explore the influence of low-quality studies, subgroup analysis was performed. The subgroup was selected based on their Jadad score (<3).
| Results|| |
Description of studies
In this meta-analysis, overall 12 articles were selected meeting our criteria.,,,,,,,,,,, Of these, study conducted by Agerholm-Larsen et al. considered three types of yogurts manufactured using three different probiotic strains and compared to the control and was considered as three different trials compared with one same control while performing the analysis. Hence, 14 studies from 12 randomized controlled trials were included in this meta-analysis. Characteristics of the studies selected are summarized in [Table 1]; includes 2 crossover and 12 parallel trials using various probiotics strains of Lactobacillus, Bifidobacterium, and Enterococcus general, a pooled total of 606 subjects participated in the trials, age ranging from 18 to 65 years and study duration varying from 4 to 12 weeks.,,,,,,,,,,, A staggering 67.32% were women participants, pooled of all the trials included. Subject's baseline mean serum TC values varied from 162.5 mg/dl to 264 mg/dl and mean LDL-cholesterol levels varied from 96.5 mg/dl to 172 mg/dl. Mean baseline HDL-cholesterol levels ranged from 39 mg/dl to 76 mg/dl and mean baseline of TG levels ranged from 57.5 mg/dl to 250 mg/dl. None of the subjects were on cholesterol-lowering drugs.
All studies were at least single-blinded, randomized controlled trials; people with Type 2 diabetes mellitus was the main inclusion criteria in the trial conducted by Ejtahed et al. and pregnant women of the third trimester in trial conducted by Asemi et al. Two trials selected in the meta-analysis used capsule , as a carrier for probiotics strains and placebo.
Outcomes of the meta-analysis
To assess the methodological quality, Jadad scale was used. Using the scale, 58.33% of the studies had a score of 3 or higher and were considered high-quality studies. Most studies were reported as randomized and double blind, but did not describe the appropriate methods for the same, reasons for low score and attributing to low quality studies. Its impact overall was however addressed in subgroup analysis on the basis of Jadad score (<3 or ≥3) for any significant difference.
Effect of probiotics on lipid profiles
The pooled mean net change for the effects of probiotics on serum TC was found to be − 8.40 mg/dl (95% confidence interval [CI]: −13.63–−3.16) with P = 0.002 and I value of 60% on random effects as shown in [Figure 1]. This shows that probiotic interventions significantly decreased serum TC levels. For LDL-cholesterol levels, the pooled mean net change by the effect of probiotics is − 6.63 mg/dl (95% CI: −10.63–−2.63) on random effects with P = 0.01 and I value of 51% [Figure 2]. Probiotic interventions thereby also showed a significant decrease in LDL-cholesterol levels.
|Figure 1: Forest plot depicting effect of probiotics on total cholesterol levels|
Click here to view
|Figure 2: Forest plot depicting effect of probiotics on LDL-cholesterol levels|
Click here to view
For HDL-cholesterol levels, the pooled mean net change by the effect of probiotics was 0.59 mg/dl (95% CI: −0.92–2.09) on fixed effects model with P = 0.84 and I value of 0%. For TG-cholesterol levels, the pooled mean net change by the effect of probiotics − 1.32 mg/dl (95% CI: −6.49–3.85) on fixed effects model with P = 0.51 and I value of 0%. No statistical significance was observed on the effects of probiotics interventions on HDL-cholesterol and TG levels.
In subgroup analysis, the influence of low-quality studies categorized on the basis of Jadad score on the changes in serum TC and LDL-cholesterol was studied. The effect of probiotics was found to be significant in lowering serum TC levels by excluding studies having a Jadad score <3 with mean difference of −8.97 (95% CI: −14.89–−3.05; P < 0.003). However, the overall effect on TC is comparable to the effect obtained when the analysis was restricted to the good quality studies (−8.40 mg/dl [95% CI: −13.63–−3.16]).
The effect of probiotics was found to be significant in lowering LDL-cholesterol levels by excluding the studies having a Jadad score of <3 with mean difference of −7.46 (95% CI: −12.14–−2.79; P < 0.002). The overall effect on LDL-cholesterol was also found to be comparable to the effect obtained when the analysis was restricted to the good quality studies.
Funnel plots obtained were interpreted visually by the method described by Sterne et al. Visual analysis of the funnel plots obtained for effect on TC and effect on LDL-cholesterol levels does not show evidence for publication bias.
| Discussion|| |
The present meta-analysis of 14 randomized clinical trials, with normo-, borderline-, and borderline high-baseline cholesterol levels there was a significant decrease in the serum TC (−8.40 mg/dl) and LDL-cholesterol levels (−6.63 mg/dl) with the consumption of probiotics as compared to control. A trend toward reduction was observed for both serum TC and LDL-cholesterol levels in 13 out of 14 trials while only six trials showed statistically significant decrease in serum TC levels and four trials in LDL-cholesterol levels respectively with the use of probiotics. However, the use of probiotics does not seem to change levels of HDL-cholesterol and TG levels significantly. Results of present meta-analysis are similar to the ones previously conducted.,,, A meta-analysis conducted by Shimizu et al. including 11 studies and 26 trials also showed significant reductions in TC and LDL-cholesterol levels. However, our inclusion criteria were limited to the use of probiotics only and not synbiotics to observe and concentrate effect of probiotics in lowering cholesterol levels.
While selecting studies, it was observed that some either used capsule or yogurt as probiotics carrier along with a matching placebo. This added significant calories in the latter while keeping their diets usual as a criterion in most of them. Hence, this difference in data could have influenced the results while comparing to other systematic reviews and under-estimated the effect of probiotics on blood lipids.
The probiotic strains analyzed in this meta-analysis were Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus plantarum, Lactobacillus rhamnosus, Bifidobacterium longum, Bifidobacterium lactis, Bifidobacterium animalis, and Enterococcus faecium. The cholesterol-lowering effect of probiotics, however, should be noted that varies from strain to strain. The use of probiotics evaluated as cholesterol-lowering adjunct has its share of limitations. First, all the studies conducted have used dosages and amounts too high to be used on the regular daily basis, the use of small daily amounts of yogurt over a long period needs to be tested and verified. Hence, a long follow-up with feasible amounts is the thrust area and must be examined using proven strains on human subjects in future studies. Second, probiotic food additive used need to ensure that they reach the colon alive and in recommended viable numbers (1 × 10 cfu/g). The viability, however, is subjective to the handling of the product (cold temperatures required) and hence the effects could be varied. Third, the mechanism suggested so far few being probiotics assimilate cholesterol in the growing cells, production of bile salt hydrolase enzyme and the incorporation in the cellular membrane to inhibit the formation of cholesterol micelles by the probiotics bacteria's will bring about a small effect compared to the cholesterol-lowering drugs., Hence, cholesterol-lowering drugs such as statins are much a preferred choice over other lifestyle initiatives by therapists. Moreover, not all patients respond equally well to the intervention treatment and hence should be kept on drugs along with lifestyle modifications.
However, many patients prefer nondrug treatments being wary of the side effects of cholesterol-lowering drugs, hence the preference for natural alternatives and self-motivation to avert the levels the natural way are also on the rise. In the end, this meta-analysis concludes with above considerations in mind that probiotics do lower serum cholesterol levels significantly and hence a reduction in the risk factor of developing CHD.
We would like to thank Dr. Tinku Thomas, Associate Professor, Epidemiology and Biostatistics, St. John's Research Institute for her technical support in cross checking the method and format of conducting a systematic review.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Aloğlu H, Öner Z. Assimilation of cholesterol in broth, cream and butter by probiotic bacteria. Eur J Lipid Sci Technol 2006;108:709-13.
Jialal I. Evolving lipoprotein risk factors: Lipoprotein (a) and oxidized low-density lipoprotein. Clin Chem 1998;44 (8 Pt 2):1827-32.
Enas EA, Chacko V, Pazhoor SG, Chennikkara H, Devarapalli HP. Dyslipidemia in South Asian patients. Curr Atheroscler Rep 2007;9:367-74.
WHO. Diet, Nutrition and Prevention of Chronic Diseases. Report of a Joint WHO/FAO Expert Consultation. Geneva, Switzerland: WHO; 2003.
FAO, WHO. Health and Nutritional Properties of Probiotics in Food Including Powder Milk with Live Lactic Acid Bacteria; Report of a Joint FAO/WHO Expert Consultation on Evaluation of Health and Nutritional Properties of Probiotics in Food Including Powder Milk with Live Lactic Acid Bacteria. Cordoba: Argentina; 1-4 October, 2001.
Sudha MR, Prashant C, Kalpana D, Sekhar B, Kaiser J. Probiotics as complementary therapy for hypercholesterolemia. Biol Med 2009;1:1-4.
Ouwehand AC. Antiallergic effects of probiotics. J Nutr 2007;137 3 Suppl 2:794S-7S.
Hirayama K, Rafter J. The role of probiotic bacteria in cancer prevention. Microbes Infect 2000;2:681-6.
Yeo SK, Liong MT. Angiotensin I-converting enzyme inhibitory activity and bioconversion of isoflavones by probiotics in soymilk supplemented with prebiotics. Int J Food Sci Nutr 2010;61:161-81.
Mercenier A, Pavan S, Pot B. Probiotics as biotherapeutic agents: Present knowledge and future prospects. Curr Pharm Des 2003;9:175-91.
Reid G, Bruce AW, Fraser N, Heinemann C, Owen J, Henning B. Oral probiotics can resolve urogenital infections. FEMS Immunol Med Microbiol 2001;30:49-52.
Gill HS, Guarner F. Probiotics and human health: A clinical perspective. Postgrad Med J 2004;80:516-26.
Pereira DI, Gibson GR. Effects of consumption of probiotics and prebiotics on serum lipid levels in humans. Crit Rev Biochem Mol Biol 2002;37:259-81.
Agerholm-Larsen L, Raben A, Haulrik N, Hansen AS, Manders M, Astrup A. Effect of 8 week intake of probiotic milk products on risk factors for cardiovascular diseases. Eur J Clin Nutr 2000;54:288-97.
Shaper AG, Jones KW, Jones M, Kyobe J. Serum lipids in three nomadic tribes of Northern Kenya. Am J Clin Nutr 1963;13:135-46.
Huang Y, Wang X, Wang J, Wu F, Sui Y, Yang L, et al.Lactobacillus plantarum
strains as potential probiotic cultures with cholesterol-lowering activity. J Dairy Sci 2013;96:2746-53.
Wang J, Zhang H, Chen X, Chen Y, Bao Q. Selection of potential probiotic lactobacilli for cholesterol-lowering properties and their effect on cholesterol metabolism in rats fed a high-lipid diet. J Dairy Sci 2012;95:1645-54.
Kumar R, Grover S, Batish VK. Hypocholesterolaemic effect of dietary inclusion of two putative probiotic bile salt hydrolase-producing Lactobacillus plantarum
strains in Sprague-Dawley rats. Br J Nutr 2011;105:561-73.
Xie N, Cui Y, Yin YN, Zhao X, Yang JW, Wang ZG, et al.
Effects of two Lactobacillus
strains on lipid metabolism and intestinal microflora in rats fed a high-cholesterol diet. BMC Complement Altern Med 2011;11:53.
Pan DD, Zeng XQ, Yan YT. Characterisation of Lactobacillus fermentum
SM-7 isolated from koumiss, a potential probiotic bacterium with cholesterol-lowering effects. J Sci Food Agric 2011;91:512-8.
Jeun J, Kim S, Cho SY, Jun HJ, Park HJ, Seo JG, et al.
Hypocholesterolemic effects of Lactobacillus plantarum
KCTC3928 by increased bile acid excretion in C57BL/6 mice. Nutrition 2010;26:321-30.
Jones ML, Martoni CJ, Parent M, Prakash S. Cholesterol-lowering efficacy of a microencapsulated bile salt hydrolase-active Lactobacillus reuteri
NCIMB 30242 yoghurt formulation in hypercholesterolaemic adults. Br J Nutr 2012;107:1505-13.
Ejtahed HS, Mohtadi-Nia J, Homayouni-Rad A, Niafar M, Asghari-Jafarabadi M, Mofid V, et al.
Effect of probiotic yogurt containing Lactobacillus acidophilus
and Bifidobacterium lactis
on lipid profile in individuals with type 2 diabetes mellitus. J Dairy Sci 2011;94:3288-94.
Andrade S, Borges N. Effect of fermented milk containing Lactobacillus acidophilus
and Bifidobacterium longum
on plasma lipids of women with normal or moderately elevated cholesterol. J Dairy Res 2009;76:469-74.
Asemi Z, Samimi M, Tabasi Z, Talebian P, Azarbad Z, Hydarzadeh Z, et al
. Effect of daily consumption of probiotic yoghurt on lipid profiles in pregnant women: a randomized controlled clinical trial. J Matern Fetal Neonatal Med 2012;25(9):1552-56.
Simons LA, Amansec SG, Conway P. Effect of Lactobacillus fermentum
on serum lipids in subjects with elevated serum cholesterol. Nutr Metab Cardiovasc Dis 2006;16:531-5.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al.
Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 1996;17:1-12.
Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: A meta-analysis. Am J Clin Nutr 1999;69:30-42.
Davis CE, Rifkind BM, Brenner H, Gordon DJ. A single cholesterol measurement underestimates the risk of coronary heart disease. An empirical example from the Lipid Research Clinics Mortality Follow-up Study. JAMA 1990;264:3044-6.
Ataie-Jafari A, Larijani B, Alavi Majd H, Tahbaz F. Cholesterol-lowering effect of probiotic yogurt in comparison with ordinary yogurt in mildly to moderately hypercholesterolemic subjects. Ann Nutr Metab 2009;54:22-7.
Bertolami MC, Faludi AA, Batlouni M. Evaluation of the effects of a new fermented milk product (Gaio) on primary hypercholesterolemia. Eur J Clin Nutr 1999;53:97-101.
de Roos NM, Schouten G, Katan MB. Yoghurt enriched with Lactobacillus acidophilus
does not lower blood lipids in healthy men and women with normal to borderline high serum cholesterol levels. Eur J Clin Nutr. 1999;53:277-80.
Fabian E, Elmadfa I. Influence of daily consumption of probiotic and conventional yoghurt on the plasma lipid profile in young healthy women. Ann Nutr Metab 2006;50:387-93.
Fuentes MC, Lajo T, Carrión JM, Cuñé J. Cholesterol-lowering efficacy of Lactobacillus plantarum
CECT 7527, 7528 and 7529 in hypercholesterolaemic adults. Br J Nutr 2013;109:1866-72.
Naruszewicz M, Johansson ML, Zapolska-Downar D, Bukowska H. Effect of Lactobacillus plantarum
299v on cardiovascular disease risk factors in smokers. Am J Clin Nutr 2002;76:1249-55.
Xiao JZ, Kondo S, Takahashi N, Miyaji K, Oshida K, Hiramatsu A, et al.
Effects of milk products fermented by Bifidobacterium longum
on blood lipids in rats and healthy adult male volunteers. J Dairy Sci 2003;86:2452-61.
Sadrzadeh-Yeganeh H, Elmadfa I, Djazayery A, Jalali M, Heshmat R, Chamary M. The effects of probiotic and conventional yoghurt on lipid profile in women. Br J Nutr 2010;103:1778-83.
Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al.
Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 2011;343:d4002.
Shimizu M, Hashiguchi M, Shiga T, Tamura HO, Mochizuki M. Meta-analysis: Effects of probiotic supplementation on lipid profiles in normal to mildly hypercholesterolemic individuals. PLoS One 2015;10(10):e0139795.
Cho YA, Kim J. Effect of probiotics on blood lipid concentrations: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2015;94:e1714.
Guo Z, Liu XM, Zhang QX, Shen Z, Tian FW, Zhang H, et al.
Influence of consumption of probiotics on the plasma lipid profile: A meta-analysis of randomised controlled trials. Nutr Metab Cardiovasc Dis 2011;21:844-50.
Agerholm-Larsen L, Bell ML, Grunwald GK, Astrup A. The effect of a probiotic milk product on plasma cholesterol: A meta-analysis of short-term intervention studies. Eur J Clin Nutr 2000;54:856-60.
Ranadheera RD, Baines SK, Adams MC. Importance of food in probiotic efficacy. Food Res Int 2010;43:1-7.
Guo Z, Liu XM, Zhang QX, Tian FW, Zhang H, Zhang HP, et al
. Research advances with regards to clinical outcome and potential mechanisms of the cholesterol-lowering effects of probiotics. Clin Lipidol 2012;7:501-7.
Liong MT, Shah NP. Acid and bile tolerance and cholesterol removal ability of lactobacilli strains. J Dairy Sci 2005;88:55-66.
[Figure 1], [Figure 2]
|This article has been cited by|
||Effects of products designed to modulate the gut microbiota on hyperlipidaemia
| ||Xilong Deng,Jie Ma,Meiting Song,Ye Jin,Cheng Ji,Weihong Ge,Changrun Guo |
| ||European Journal of Nutrition. 2018; |
|[Pubmed] | [DOI]|
||The effects of probiotics on total cholesterol
| ||Lang Wang,Mao-Juan Guo,Qing Gao,Jin-Feng Yang,Lin Yang,Xiao-Li Pang,Xi-Juan Jiang |
| ||Medicine. 2018; 97(5): e9679 |
|[Pubmed] | [DOI]|
||Effect of probiotics on lipid profiles in hypercholesterolaemic adults: A meta-analysis of randomized controlled trials
| ||Rui Mo,Xingwei Zhang,Yunsheng Yang |
| ||Medicina Clínica. 2018; |
|[Pubmed] | [DOI]|
||Emerging Topics in Gastroenterology
| ||Gretchen Irwin,Laura Mayans,Rick Kellerman |
| ||Primary Care: Clinics in Office Practice. 2017; |
|[Pubmed] | [DOI]|