The effect of probiotics on weight management in patients with severe obesity undergoing metabolic and bariatric surgery: a systematic review and meta-analysis

Although metabolic and bariatric surgery (MBS) remains an effective intervention for severe obesity, postoperative weight regain persists as a significant clinical challenge. Probiotics have emerged as a potential adjunct therapy to optimize outcomes, but their efficacy in weight management remains controversial. This meta-analysis evaluates the effect of probiotics supplementation on weight management in patients following MBS. A comprehensive search strategy was executed across four databases (PubMed, Embase, Scopus and Cochrane Library) from inception to April 10th, 2025. Inclusion criteria encompassed randomized controlled trials comparing probiotics with placebo in patients with severe obesity undergoing MBS. Primary outcomes including percent excess weight loss (%EWL), postoperative body mass index (BMI), and BMI reduction. Data were pooled using the random-effects model. A total of 13 trials included 693 patients were finally analyzed in the meta-analysis. Pooled analysis demonstrated no significant difference in %EWL (MD 0.39, 95% CI −1.90 to 2.68, I2=43%), postoperative BMI (MD 0.07, 95% CI −0.21 to 0.35, I2=26%), and BMI reduction (MD −0.05, 95% CI −0.53 to 0.44, I2=60%) between probiotics and control groups. Subgroup analyses stratified by surgery type, probiotic formulation and treatment duration similarly revealed no clinically meaningful effects. Current evidence does not support the routine use of probiotics for enhancing weight loss after MBS, regardless of surgical technique and treatment duration. Further large-scale trials standardizing strains, dosages, and outcome metrics are warranted.

尽管代谢减重手术（Metabolic and Bariatric Surgery, MBS）仍是治疗重度肥胖的有效干预手段，但术后体重反弹仍是一项重大临床难题。益生菌已成为优化术后治疗结局的潜在辅助疗法，但其在体重管理中的疗效仍存在争议。本荟萃分析旨在评估益生菌补充疗法对代谢减重手术后患者体重管理的影响。研究针对PubMed、Embase、Scopus及Cochrane图书馆四大数据库，自建库起至2025年4月10日开展了全面文献检索。纳入标准限定为针对接受代谢减重手术的重度肥胖患者、对比益生菌与安慰剂的随机对照试验。主要结局指标包括额外体重丢失率（%EWL）、术后体重指数（Body Mass Index, BMI）及体重指数降幅。本研究采用随机效应模型对数据进行合并分析。本荟萃分析最终纳入13项试验，共涉及693例患者。合并分析结果显示，益生菌组与对照组在额外体重丢失率（%EWL）（均差MD=0.39，95%置信区间CI：-1.90~2.68，I²=43%）、术后BMI（MD=0.07，95%CI：-0.21~0.35，I²=26%）及体重指数降幅（MD=-0.05，95%CI：-0.53~0.44，I²=60%）方面均无显著差异。按手术类型、益生菌制剂及治疗时长进行的亚组分析，同样未发现具有临床意义的干预效果。现有证据不支持在代谢减重手术后常规使用益生菌以强化体重丢失效果，且该结论不受手术术式及治疗时长的影响。未来亟需开展标准化菌株、剂量及结局指标的大规模临床试验。