Table 3.
Main findings of included meta-analyses investigating the overall and subgroup effects of probiotics and synbiotics supplementation on PCOS.
| Health indicator group | Health indicator | Number of meta-analyses | References | Number of original articles (number of participants) | Mean difference [95% CI] | Significance | Heterogenicity |
|---|---|---|---|---|---|---|---|
| Probiotics/synbiotics | |||||||
| Anthropometrics | BMI | 5 | Hadi et al. (22) | 7 (386) | −0.23 [−0.55, 0.08] | No | I2 = 92.6 |
| Li et al. (24) | 13 (791) | −0.10 [−0.30, 0.09] | No | I2 = 47.3 | |||
| Tabrizi et al. (25) | 9 (506) | −0.29 [−0.54, – 0.03] | Yes | I2 = 50.7 | |||
| Cozzolino et al. (28) | 7 (416) | −0.25 [−0.48, −0.03] | Yes | I2 = 97 | |||
| Miao et al. (23) | 4 (262) | −0.74 [−1.58, 0.11] | No | I2 = 0 | |||
| BW | 5 | Li et al. (24) | 12 (731) | −0.11 [−0.34, 0.13] | No | I2 = 61.5 | |
| Hadi et al. (22) | 7 (386) | −0.67 [−1.43, 0.10] | No | I2 = 90.8 | |||
| Tabrizi et al. (25) | 9 (506) | – 0.30 (−0.53, −0.07] | Yes | I2 = 42.5 | |||
| Cozzolino et al. (28) | 7 (416) | −0.75 [−1.45, −0.05] | Yes | I2 = 97 | |||
| Li et al. (24) | 5 (316) | 0.37 [−0.78, 1.53] | No | I2 = 95.5 | |||
| HC | 1 | Li et al. (24) | 4 (256) | −0.25 [−0.78, 0.27] | No | I2 = 76.9 | |
| Lipids | HDL-C | 5 | Li et al. (24) | 7 (428) | 0.53 [−0.33, 1.39] | N0 | I2 = 94.3 |
| Tabrizi et al. (25) | 3 (180) | 0.04 [– 0.25, 0.33] | No | I2 = 0 | |||
| Heshmati et al. (27) | 3 (119) | 1.55 [0.28, 2.81] | Yes | I2 = 0 | |||
| LDL-C | Tabrizi et al. (25) | 3 (180) | – 0.12 [– 0.66, 0.42] | No | I2 =70.2 | ||
| VLDL-C | 2 | Li et al. (24) | 7 (428) | −0.84 [−1.64, −0.03] | Yes | I2 = 93.4 | |
| Li et al. (24) | 4 (235) | −0.44 [−0.70, −0.18] | Yes | I2 = 0 | |||
| Tabrizi et al. (25) | 3 (180) | – 0.69 [−0.99, – 0.39] | Yes | I2 = 0 | |||
| TC | 2 | Heshmati et al. (27) | 3 (208) | 0.99 [−5.31, 7.29] | No | I2 = 0 | |
| Tabrizi et al. (25) | 3 (180) | – 0.26 [– 0.67, 0.15] | No | I2 = 48.4 | |||
| TG | 4 | Heshmati et al. (27) | 3 (119) | −17.51 [−29.65, −5.36] | Yes | I2 = 32 | |
| Cozzolino et al. (28) | 2 (120) | −23.35 [−35.23, −11.47] | Yes | I2 = 0 | |||
| Li et al. (24) | 7 (428) | −0.85 [−1.59, −0.11] | Yes | I2 = 92.2 | |||
| Tabrizi et al. (25) | 3 (180) | – 0.69 [– 0.99, – 0.39] | Yes | I2 = 0 | |||
| Glucose homeostasis | FBS | 2 | Hadi et al. (22) | 6 (360) | −2.52 [−4.10, −0.95] | Yes | I2 = 0 |
| Miao et al. (23) | 4 (265) | −1.94 [−5.53, 1.65] | No | I2 = 91 | |||
| FPG | 4 | Heshmati et al. (27) | 4 (291) | −3.38 [−7.08, 0.31] | Yes | I2 = 81 | |
| Cozzolino et al. (28) | 5 (337) | −3.45 [−6.03, −0.88] | Yes | I2 = 84 | |||
| Li et al. (24) | 8 (496) | −1.35 [−2.22,−0.49] | Yes | I2 = 94.6 | |||
| Tabrizi et al. (25) | 7 (430) | – 0.26 [−0.45, – 0.07] | Yes | I2 = 0 | |||
| HOMA-IR | 6 | Hadi et al. (22) | 6 (360) | −0.69 [−0.98, −0.40] | Yes | I2 = 40.2 | |
| Heshmati et al. (27) | 4 (291) | −0.48 [−0.97, −0.02] | No | I2 = 74 | |||
| Cozzolino et al. (28) | 5 (337) | −2.31 [−3.84, −0.77] | Yes | I2 = 94 | |||
| Miao et al. (23) | 5 (325) | −0.37 [−0.69, −0.05] | Yes | I2 = 58 | |||
| Li et al. (24) | 7 (434) | −0.73 [−1.15, −0.31] | Yes | I2 = 78.1 | |||
| Tabrizi et al. (25) | 7 (430) | – 0.53 [– 0.79, – 0.26] | Yes | I2 = 44.5 | |||
| FBI | 4 | Hadi et al. (22) | 6 (360) | −2.27 [−3.40, −1.14] | Yes | I2 = 42.9 | |
| Heshmati et al. (27) | 4 (291) | −2.14 [−4.24, −0.04] | Yes | I2 = 73 | |||
| Li et al. (24) | 7 (434) | −0.68 [−1.08, −0.27] | Yes | I2 = 76.7 | |||
| Tabrizi et al. (25) | 7 (430) | – 0.52 [– 0.81, – 0.24] | Yes | I2 = 52.2 | |||
| QUICKI | 4 | Heshmati et al. (27) | 4 (291) | 0.41 [0.01, 0.82] | Yes | I2 = 66 | |
| Cozzolino et al. (28) | 5 (337) | −0.62 [−1.07, −0.17] | Yes | I2 = 89 | |||
| Li et al. (24) | 6 (379) | 2.00 [−0.79, 3.22] | Yes | I2 = 96.1 | |||
| Tabrizi et al. (25) | 7 (430) | 0.41 [0.11, 0.70] | Yes | I2 = 55.5 | |||
| Inflammation and antioxidant | GSH | 3 | Shamasbi et al. (26) | 3 (180) | 0.53 [−0.00, 1.06] | Yes | I2 = 68 |
| Cozzolino et al. (28) | 3 (180) | 22.42 [2.08, 42.75] | Yes | I2 = 25 | |||
| Tabrizi et al. (25) | 4 (240) | 0.26 [0.01, 0.52] | Yes | I2 = 0 | |||
| MDA | 2 | Shamasbi et al. (26) | 3 (180) | −0.76 [−1/46,−0.05] | Yes | I2 = 81 | |
| Tabrizi et al. (25) | 4 (240) | – 0.90 [−1.16, – 0.63] | Yes | I2 = 0 | |||
| NO | 3 | Shamasbi et al. (26) | 3 (180) | 0.38 [0.09, 0.68] | Yes | I2 = 0 | |
| Cozzolino et al. (28) | 3 (180) | 2.72 [0.08, 0.59] | Yes | I2 = 26 | |||
| Tabrizi et al. (25) | 4 (240) | 0.33 [– 2.14, – 0.37] | Yes | I2 = 0 | |||
| CRP | 4 | Heshmati et al. (27) | 2 (153) | 0.92 [−0.57, 2.40] | No | I2 = 73 | |
| Li et al. (24) | 9 (558) | −0.63 [−1.37, 0.10] | No | I2 = 93.9 | |||
| Tabrizi et al. (25) | 7 (464) | – 1.26 [– 2.14, – 0.37] | Yes | I2 = 94.6 | |||
| Hadi et al. (22) | 5 (334) | −1.69 [−3.00, −0.38] | Yes | I2 = 96.5 | |||
| hsCRP | 3 | Shamasbi et al. (26) | 8 (567) | −0.59 [−1.60, 0.42] | No | I2 = 96 | |
| Heshmati et al. (27) | 3 (180) | −0.00 [−1.46, 1.46] | No | I2 = 95 | |||
| Cozzolino et al. (28) | 4 (240) | −1.69 [−2.38, −1.01] | Yes | I2 = 49 | |||
| TAC | 3 | Shamasbi et al. (26) | 3 (180) | 0.30 [−0.58, 1.17] | No | I2 = 88 | |
| Cozzolino et al. (28) | 3 (180) | 70.55 [38.84, 102.25] | Yes | I2=25 | |||
| Tabrizi et al. (25) | 4 (240) | 0.64 [0.38, 0.90] | Yes | I2 = 0 | |||
| Hormones | SHBG | 2 | Shamasbi et al. (26) | 3 (180) | 0.56 (0.26, 0.86] | Yes | I2 = 0 |
| Tabrizi et al. (25) | 4 (240) | 0.46 [0.08, 0.85] | Yes | I2 =55.7 | |||
| DHEA-S | 2 | Shamasbi et al. (26) | 3 (182) | −0.22 [−0.51, 0.07] | No | I2 = 0 | |
| Tabrizi et al. (25) | 2 (120) | 0.06 [– 0.77, 0.89] | No | I2 =80.8 | |||
| Total testosteron | 4 | Hadi et al. (22) | 4 (206) | −0.12 [−0.17, −0.08] | Yes | I2 = 43.4 | |
| Shamasbi et al. (26) | 3 (180) | −0.50 [−1.25, 0.25] | No | I2 = 84 | |||
| Cozzolino et al. (28) | 4 (226) | −0.23 [−0.36, −0.11] | Yes | I2 = 52 | |||
| Tabrizi et al. (25) | 6 (326) | – 0.58 [– 0.82, – 0.34] | Yes | I2 = 10.4 | |||
| FAI | 1 | Shamasbi et al. (26) | 2 (120) | −0.58 [−0.95, 00.21] | Yes | I2 = 68 | |
| Clinical symptoms | Hirsutism | 1 | Shamasbi et al. (26) | 4 (242) | −0.12 [−0.38, 0.13] | No | I2 = 50 |
| Synbiotics | |||||||
| Anthropometrics | BMI | 4 | Hadi et al. (22) | 4 (206) | −0.03 [−0.25, 0.19] | No | I2 = 43.2 |
| Li et al. (24) | 4 (254) | −0.13 [−0.53, 0.26] | No | I2 = 58.90 | |||
| Tabrizi et al. (25) | 4 | – 0.03 [– 0.30, 0.25] | I2 = 0.0 | ||||
| Cozzolino et al. (28) | 3 (166) | −0.19 [−0.74, 0.36] | No | I2 = 98* | |||
| BW | 3 | Hadi et al. (22) | 4 (206) | −0.08 [−0.58, 0.39] | No | I2 = 17.9 | |
| Cozzolino et al. (28) | 3 (166) | −0.66 [−2.31, 0.98] | No | I2 = 98* | |||
| Li et al. (24) | 4 (254) | 0.12 [−0.49, 0.25] | No | I2 = 53.50 | |||
| WC | 2 | Miao et al. (23) | 3 (207) | −1.88 [−4.88, 1.12] | No | I2 = 63* | |
| Li et al. (24) | 2 (134) | −0.48 [−1.52, 0.56] | No | I2 = 87.20 | |||
| HC | 1 | Li et al. (24) | 2 (134) | −0.21 [−0.92, 0.50] | No | I2 = 74.20 | |
| Lipids | HDL-C | 2 | Li et al. (24) | 3 (191) | 0.09 [−0.48, 0.65] | No | I2 = 72.70 |
| Heshmati et al. (27) | 2 (159) | 1.64 [0.33, 2.94] | Yes | I2 = 0* | |||
| LDL–C | 3 | Heshmati et al. (27) | 2 (159) | −5.59 [−9.58, −1.61] | Yes | I2 = 0 | |
| Tabrizi et al. (25) | 1 | – 0.07 [– 0.57, 0.44] | NA | ||||
| Li et al. (24) | 3 (191) | −0.22 [−0.51, 0.06] | No | I2 = 0 | |||
| VLDL–c | 1 | Li et al. (24) | 1 (60) | −0.32 [−0.83, 0.19] | No | NA | |
| TC | 2 | Heshmati et al. (27) | 2 (148) | −0.22 [−9.41, 8.97] | No | I2 = 32 | |
| Li et al. (24) | 3 (191) | −0.28 [−0.56, 0.01] | No | I2 = 0 | |||
| TG | 2 | Heshmati et al. (27) | 2 (159) | −14.54 [−30.54, 1.45] | Yes | I2 = 53 | |
| Li et al. (24) | 3 (191) | −0.14 [−0.47, 0.20] | No | I2 = 25.20 | |||
| Glucose homeostasis | FBS | 1 | Hadi et al. (22) | 4 (345) | −2.05 [−3.79, −0.31] | Yes | I2 = 0 |
| FPG | 3 | Heshmati et al. (27) | 2 (159) | −0.77 [−4.53, 2.99] | No | I2 = 82 | |
| Cozzolino et al. (28) | 3 (205) | −1.50 [−2.03, −0.98] | Yes | I2 = 0* | |||
| Li et al. (24) | 3 (194) | −0.36 [−0.87, 0.15] | No | I2 = 67.70 | |||
| HOMA-IR | 4 | Hadi et al. (22) | 4 (245) | −0.82 [−1.10, −0.53] | Yes | I2 = 14.1 | |
| Li et al. (24) | 3 (194) | −0.74 [−1.59, 0.11] | No | I2 = 87.20 | |||
| Heshmati et al. (27) | 2 (159) | −0.50 [−1.72, 0.71] | No | I2 = 77 | |||
| Cozzolino et al. (28) | 3 (205) | −2.75 [−4.56, −0.95] | Yes | I2 = 55* | |||
| FBI | 5 | Hadi et al. (22) | 4 (245) | −2.40 [−3.81, −0.99] | Yes | I2 = 49.7 | |
| Li et al. (24) | 3 (194) | −0.67 [−1.54, 0.20] | No | I2 = 87.90 | |||
| Heshmati et al. (27) | 2 (159) | −2.38 [−6.96, 2.20] | No | I2 = 77 | |||
| Miao et al. (23) | 4 (270) | −0.66 [−1.19, −0.12] | Yes | I2 = 78* | |||
| Tabrizi et al. (25) | 4 | – 0.50 [−0.93, −0.06] | I2 = 63.5 | ||||
| QUICKI | 4 | Heshmati et al. (27) | 2 (159) | 0.43 [−0.42, 1.28] | No | I2 = 85 | |
| Li et al. (24) | 3 (194) | 0.92 [−0.12, 1.96] | No | I2 = 91 | |||
| Cozzolino et al. (28) | 3 (205) | −0.80 [−1.20, −0.39] | Yes | I2 = 46* | |||
| Tabrizi et al. (25) | 4 | 0.44[– 0.05, 0.92] | I2 = 70.2 | ||||
| Inflammation and antioxidant | GSH | 1 | Shamasbi et al. (26) | 1 (60) | 0.02 [−0.48, 0.53] | No | Na |
| MDA | 1 | Shamasbi et al. (26) | 1 (60) | −0.66 [−1.18, −0.14] | Yes | NA | |
| NO | 1 | Shamasbi et al. (26) | 1 (60) | 0.49 [−0.02, 1.00] | No | Na | |
| CRP | 3 | Hadi et al. (22) | 2 (159) | −0.51 [−0.83, −0.20] | Yes | I2 = 0 | |
| Li et al. (24) | 3 (191) | −0.50 [−1.16, 0.15] | No | I2 = 79.10 | |||
| Tabrizi et al. (25) | 2 | 0.52 [– 0.83, – 0.20] | I2 = 0 | ||||
| hsCRP | 1 | Shamasbi et al. (26) | 2 (159) | −0.47 [−1.97, 1.03] | No | I2 = 95 | |
| TAC | 1 | Shamasbi et al. (26) | 1 (60) | −0.52 [−1.03, −0.00] | Yes | Na | |
| Hormones | SHBG | 1 | Shamasbi et al. (26) | 1 (60) | 0.49 [−0.02, 1.01] | No | Na |
| DHEA-S | 1 | Shamasbi et al. (26) | 1 (60) | −0.31 [−0.82, 0.20] | No | Na | |
| Total testosteron | 2 | Shamasbi et al. (26) | 1 (60) | 0.10 [−0.40, 0.61] | No | Na | |
| Cozzolino et al. (28) | 2 (106) | −0.15 [−0.16, −0.14] | Yes | I2 = 0 | |||
| FAI | 1 | Shamasbi et al. (26) | 1 (60) | −0.26 [−0.77, 0.25] | No | Na | |
| Clinical symptoms | Hirsutism | 1 | Shamasbi et al. (26) | 1 (60) | −0.23 [−0/74, 0.28] | No | NA (not applicable) |
| Probiotics | |||||||
| Anthropometrics | BMI | 5 | Hadi et al. (22) | 3 (180) | −0.36 [−0.74, 0.02] | No | I2 = 91.3 |
| Li et al. (24) | 8 (475) | −0.03 [−0.24, 0.19] | No | I2 = 31.80 | |||
| Tabrizi et al. (25) | 5 | −0.29 [– 0.79, – 0.14] | Yes | I2 = 48.6 | |||
| Cozzolino et al. (28) | 4 (250) | −0.31 [−0.65, 0.03] | Yes | I2 = 96 | |||
| BW | 3 | Li et al. (24) | 7 (415) | −0.02 [−0.36, 0.31] | No | I2 = 66.20 | |
| Hadi et al. (22) | 3 (180) | −1.3 [−1.93, −0.13] | Yes | I2 = 90.6 | |||
| Cozzolino et al. (28) | 4 (250) | −0.80 [−1.76, 0.15] | No | I2 = 97 | |||
| WC | 1 | Li et al. (24) | 2 (120) | 1.87[−0.91, 4.65] | No | I2 = 97.20 | |
| HC | 1 | Li et al. (24) | 1 (60) | 0.25 [−0.26, 0.75] | No | NA | |
| Lipids | HDL-C | 3 | Li et al. (24) | 3 (175) | −0.17 [−0.98, 0.63] | No | I2 = 85.90 |
| Li et al. (24) | 3 (175) | −0.17 [−0.98, 0.63] | NO | I2 = 85.90 | |||
| Heshmati et al. (27) | 1 (60) | −0.10 [−5.60, 5.40] | No | Na | |||
| LDL-C | 3 | Heshmati et al. (27) | 1 (60) | 8.30 [−4.50, 21.10] | No | Na | |
| Li et al. (24) | 3 (175) | −0.13 [−0.42, 0.17] | NO | I2 = 0 | |||
| Tabrizi et al. (25) | 2 | – 0.15 [−1.09, 0.79] | Yes | I2 = 85 | |||
| VLDL-c | 1 | Li et al. (24) | 3 (175) | −0.48 [−0.78, −0.18] | YES | I2 = 0 | |
| TC | 2 | Heshmati et al. (27) | 1 (60) | 2.80 [−11.36, 16.96] | No | Na | |
| Li et al. (24) | 3 (175) | −0.26 [−0.85, 0.32] | Yes | I2 = 73.50 | |||
| TG | 2 | Heshmati et al. (27) | 1 (60) | −26.90 [−49.55, −4.25] | Yes | Na | |
| Li et al. (24) | 3 (175) | −0.50 [−0.80, −0.20] | Yes | I2 = 0 | |||
| Glucose homeostasis | FBS | 1 | Hadi et al. (22) | 2 (120) | −4.70 [−8.43, −0.96] | Yes | I2 = 0 |
| FPG | 3 | Heshmati et al. (27) | 2 (132) | −6.23 [−8.07, −4.40] | Yes | I2 = 0 | |
| Cozzolino et al. (28) | 2 (132) | −6.23 [−8.07, −4.40] | Yes | I2 = 0 | |||
| Li et al. (24) | 4 (240) | −0.96 [−1.86, −0.07] | Yes | I2 = 90.50 | |||
| HOMA-IR | 4 | Hadi et al. (22) | 2 (115) | −0.47 [−1.05, 0.12] | No | I2= 52.9 | |
| Li et al. (24) | 4 (240) | −0.74 [1.25, 0.23] | Yes | I2 = 73.10 | |||
| Heshmati et al. (27) | 2 (132) | −0.41 [−0.98, 0.15] | No | I2 = 70 | |||
| Cozzolino et al. (28) | 2 (132) | −1.87 [−4.50, 0.76] | No | I2 = 74 | |||
| FBI | 4 | Hadi et al. (22) | 2 (115) | −2.07 [−4.76, 0.63] | No | I2 = 59.8 | |
| Li et al. (24) | 4 (240) | −0.70 [−1.13, −0.26] | Yes | I2 = 63.60 | |||
| Tabrizi et al. (25) | 3 | – 0.57 [– 0.98, – 0.16] | Yes | I2 = 47.5 | |||
| Heshmati et al. (27) | 2 (132) | −1.87 [−4.50, 0.76] | No | I2 = 74 | |||
| QUICKI | 3 | Heshmati et al. (27) | 2 (132) | 0.42 [−0.07, 0.91] | No | I2 = 50 | |
| Li et al. (24) | 3 (185) | 3.65 [0.71, 6.58] | Yes | I2 = 98.10 | |||
| Tabrizi et al. (25) | 3 | 0.38 [0.01, 0.77] | Yes | I2 = 41.3 | |||
| Cozzolino et al. (28) | 2 (132) | −0.41 [−0.98, 0.15] | No | I2 = 70 | |||
| Inflammation and antioxidant | GSH | 1 | Shamasbi et al. (26) | 2 (120) | −0.81 [−2.04, 0.42] | No | NA |
| MDA | 1 | Shamasbi et al. (26) | 2 (120) | 0.78 [0.41, 1.15] | Yes | I2 = 0 | |
| NO | 1 | Shamasbi et al. (26) | 2 (120) | 0.33 [−0.03, 0.69] | Yes | I2 = 0 | |
| CRP | 32 | Hadi et al. (22) | 3 (175) | −2.80 [−5.75, 0.15] | No | I2 = 98.2 | |
| Tabrizi et al. (25) | 5 | – 1.73[– 3.13, – 0.33] | Yes | I2 = 96.4 | |||
| Li et al. (24) | 5 (305) | −0.12 [−1.01, 0.77] | No | I2=92.90 | |||
| hsCRP | 1 | Shamasbi et al. (26) | 5 (346) | 0.09 [−1.13, 1.30] | No | I2 = 95 | |
| TAC | 1 | Shamasbi et al. (26) | 2 (120) | 0.70 [0.08, 1.32] | Yes | I2 = 64 | |
| Hormones | SHBG | 1 | Shamasbi et al. (26) | 2 (120) | 0.59 [0.23, 0.96] | Yes | I2 = 0 |
| DHEA-S | 1 | Shamasbi et al. (26) | 1 (60) | 0.00 [−0.51, 0.51] | No | Na | |
| Total testosteron | 2 | Shamasbi et al. (26) | 2 (120) | −0.80 [−1.63, 0.03] | No | I2 = 79 | |
| Cozzolino et al. (28) | 2 (120) | −0.32 [−0.46, −0.18] | Yes | I2 = 0 | |||
| FAI | 1 | Shamasbi et al. (26) | 1 (60) | −0.93 [−1.46, −0.39] | Yes | Na | |
| Clinical symptoms | hirsutism | 1 | Shamasbi et al. (26) | 2 (120) | 0.15 [−0/21, 0.51] | No | I2 = 0 |
BMI, Body mass index; CRP, C reactive protein; FAI, Free Androgen Index; FBS: fasting blood sugar; FPG, fasting plasma glucose; FBI, fasting blood insulin; GSH, total glutathione; HC, hip circumference; HDL-C, high density lipoprotein-cholesterol; HOMA-IR, homeostatic model assessment-insulin resistance; hsCRP, high sensitive C reactive protein; MDA, malondialdehyde; NO, nitric oxide; QUICKI, quantitative insulin sensitivity check index; SHBG, sex hormone binding globulin; TG, triglycerides; TAC, total antioxidant capacity; VLDL-C, very low density lipoprotein-cholesterol.