Mohammad Amirul Izzan Amran
1 
, Siong Meng Lim
1* , Chin Fen Neoh
1 , Abu Bakar Abdul Majeed
2 , Anis Safura Ramli
3,4 , Kalavathy Ramasamy
1* 1 Collaborative Drug Discovery Research (CDDR) Group, Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, 42300 Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia
2 Brain Degeneration and Therapeutics Group, Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, 42300 Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia
3 Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), 47000 Sungai Buloh, Selangor Darul Ehsan, Malaysia
4 Cardiovascular Advancement and Research Excellence Institute (CARE Institute), Universiti Teknologi MARA (UiTM), 47000 Sungai Buloh, Selangor Darul Ehsan, Malaysia
Abstract
Purpose: This systematic review appraised previous findings to uncover the potential of pro-/ pre-/ synbiotics on regulation of gut microbiota and lipid profiles of patients with dyslipidaemia or cardiovascular diseases (CVD). Method: The literature search was performed using PubMed, Scopus, ScienceDirect and the Cochrane Library. Studies were shortlisted based on the inclusion and exclusion criteria and evaluated for risk of bias using the “RoB 2” tool and the NIH quality assessment tool for before-after (Pre-Post) studies with no control group. Due to heterogeneity, a narrative synthesis was performed. Results: 21 publications were shortlisted, including parallel, crossover and pre-post designs. Most studies were high risk of bias (n=17). Synbiotic interventions (low risk studies from a single trial) demonstrated significant changes in gut microbiota, including increased Bacteroidetes and Bifidobacterium spp., alongside an increase in high-density lipoprotein cholesterol (HDL-C). Pro-/ and prebiotic interventions were also associated with increases in beneficial taxa (Bifidobacterium spp., Faecalibacterium spp., Lactobacillus spp.) and improvements in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). However, with gut microbiota diversity and composition as the primary outcome, findings were inconclusive with most studies presenting high risk of bias due to considerable heterogeneity in study designs, interventions, and microbiota assessment methods. Conclusion: Evidence from this review remains inconclusive regarding the potential of microbiota-targeted therapies (pro-/ pre-/ and synbiotic) towards dyslipidaemia or CVD due to considerable heterogeneity in microbiota assessment, interventions, study designs and predominance of high risk of bias throughout the studies. This highlights the importance of well-designed and standardised clinical trials.