Modificações na composição corporal, perfil cardiometabólico e concentração sérica de lipopolissacarídeo após ensaio clínico randomizado com suplementação de probióticos em indivíduos com hipertensão e sobrepeso ou obesidade: estudo de seguimento

Abstract

Introduction: Although obesity and other cardiometabolic risk factors (CMRFs) are associated with alterations in the gut microbiota, it is still unclear whether gut dysbiosis is a cause or a consequence. Randomized controlled trials (RCTs) on the effects of probiotics on body adiposity and CMRFs have shown inconsistent results, and to date, it is unknown whether the potential beneficial effects are maintained after the end of these studies. Objective: To evaluate changes in body composition, glucose metabolism, lipid profile, blood pressure (BP), and serum lipopolysaccharide (LPS) 6 months after an RCT with probiotics in individuals with hypertension (HTN) and overweight or obesity. Methods: A 12-week, double-blind, placebo-controlled, 6-month follow-up study was performed. Adults (40-65 years) with a body mass index (BMI) ≥25 and <40 kg/m² and a diagnosis of HT were included. Participants were allocated into 2 groups: probiotic group (PG) supplemented with L. acidophilus (La-14), B. lactis (Bl-04), B. longum (Bl-05), L. casei (Lc-11), L. rhamnosus (Lr-32), L. plantarum (Lp-115), L. salivarius (Ls-33), B. brevis (Bb-03), in capsules (3x1010UFC/day) or control group (CG) received placebo capsules. Both groups followed a hypocaloric diet in the RCT. Anthropometric assessments, body composition by bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry, laboratory (including LPS), BP and food intake were performed at baseline, after 12 weeks of intervention and six months after the RCT. Results: Fifty-one individuals participated in the RCT, of which 44 underwent the follow-up assessment. Regarding body adiposity, 6 months after the RCT, the PG showed a significant reduction in waist circumference and waist-to-height ratio, with the other parameters maintained, while the CG showed a significant increase in body weight and BMI, with other variables maintained. PG showed an increase in body cell mass (BCM) and phase angle (FA), while the CG showed an increase in lean mass (LBM) and BCM, which had decreased during the RCT. During RCT, PG showed a reduction in glycated hemoglobin and BP, these effects were not maintained at follow-up, with elevations. While CG showed an increase in insulin and HOMA-IR at follow-up, despite no reduction during the RCT. HDL-cholesterol increased in both groups, but LDL-cholesterol decreased only in the CG. LPS concentrations decreased only in the PG during the RCT, with maintenance during the follow-up period. In the dietary intake analysis, although there was no significant difference between groups, CG demonstrated greater adherence to caloric restriction, while the PG increased saturated fat consumption. In the comparison between groups, 6 months after RCT, PG showed greater elevations in LF and LDL cholesterol (p < 0.05). Conclusion: The findings suggest, in the long term, after discontinuing probiotic supplementation associated with energy restriction, there may be beneficial effects on lean mass and no protection against lipid profile worsening in individuals with hypertension and excess body weight. The reduction in LPS only in the PG during the RCT, without elevation during follow-up, motivates further studies.