Effects of Prebiotics, Probiotics, or Synbiotics on Health Outcomes, Sex Hormones, Oxidative Stress, and Inflammatory Biomarkers in Women with Polycystic Ovary Syndrome: A GRADE Systematic Review, Meta-Analysis of Randomized Controlled Trials, and Umbrella Review.

Numerous individual studies have examined the effects of biotics on isolated health outcomes in women with polycystic ovary syndrome (PCOS). However, a comprehensive evaluation of their impact on the full metabolic panel and sex hormone profiles is lacking. Accordingly, this meta-analysis of RCTs and umbrella review attempted to form a complete picture of the overall efficacy of biotics on human metabolism and endocrine function. The PubMed, Scopus, Cochran, Web of Science, and Embase databases were used for conducting a comprehensive systematic search. Twenty RCTs were included in the meta-analysis and 11 meta-analyses were included for umbrella review. The pooled estimates of the studies evaluating the effects of biotics on anthropometric measurements indicated that biotics are associated with an improvement in weight (SMD: -1.21, 95%CI: -2.06, -0.36) and body mass index (BMI) (SMD: -0.77, 95%CI: -1.45, -0.10), waist circumference (WC) (SMD: -0.67, 95%CI: -1.18, -0.16), waist-to-hip ratio (WHR) (SMD: -0.84, 95%CI: -1.52, -0.15), glycemic control fasting plasma glucose (FPG) (SMD: -0.71, 95%CI: -1.19, -0.24), insulin (SMD: -0.64, 95%CI: -1.07, -0.21), and HOMA-IR (SMD: -0.78, 95%CI: -1.24, -0.32), total cholesterol (TC) (SMD: -0.69, 95%CI: -1.25, -0.13), low-density lipoprotein-cholesterol (LDL) (SMD: -0.71, 95%CI: -1.21, -0.20), high-density lipoprotein-cholesterol (HDL) (SMD: 0.39, 95%CI: 0.19, 0.60), triglyceride (TG) (SMD: -0.53, 95%CI: -0.95, -0.10), oxidative stress biomarkers such as malondialdehyde (MDA) (SMD: -0.96, 95%CI: -1.29, -0.63), total antioxidant capacity (TAC) (SMD: 0.59, 95% CI: 0.29, 0.89), testosterone (TT) (SMD: -1.29, 95%CI: -1.98, -0.68) level. However, umbrella review showed that biotics may contribute to an improvement in weight, BMI, WC, FPG, insulin, HOMA-IR, QUICKI, lipid profile, CRP, oxidative stress markers (MDA, TAC), TT and LH/FSH ratio too. In conclusion, this meta-analysis and umbrella review provide evidence that prebiotics, probiotics, or synbiotics may confer beneficial effects on a range of health outcomes among patients with PCOS.