Effects of probiotic intervention on serum lipid profiles: current evidence from systematic review and meta-analysis of randomized controlled trials

Dyslipidemia is a major risk factor for cardiovascular and metabolic diseases. Evidence suggests that probiotics may improve serum lipid profiles through multiple mechanisms, including bile salt hydrolase activity, cholesterol assimilation, conversion of cholesterol into coprostanol, deconjugation and precipitation of cholesterol by probiotic enzymes, regulation of host gene expression related to lipid metabolism, and production of short-chain fatty acids, although the magnitude and consistency of these effects across studies remain uncertain. This study aimed to evaluate the efficacy of probiotic intervention on serum lipid profiles, including triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). A systematic search was performed in PubMed, Embase, Scopus, and Cochrane Library up to February 2025. Data were pooled using a random-effects model, and mean differences with 95% confidence intervals were calculated. A total of 155 RCTs (n = 9,906) were included. Probiotic intervention significantly reduced triglyceride (MD = −10.83 mg/dL, p < 0.0001), total cholesterol (MD = −8.46 mg/dL, p < 0.0001), and LDL-C (MD = −5.83 mg/dL, p < 0.0001), while contributed to modestly increased in HDL-C (MD = 1.28 mg/dL, p < 0.0001). Overall, probiotics significantly improve serum lipid profiles, supporting their role as an adjunctive approach to dyslipidemia management.