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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Microbiol.</journal-id>
<journal-title>Frontiers in Microbiology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Microbiol.</abbrev-journal-title>
<issn pub-type="epub">1664-302X</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fmicb.2025.1633434</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Microbiology</subject>
<subj-group>
<subject>Systematic Review</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Effects of <italic>Bifidobacterium</italic> on metabolic parameters in overweight or obesity adults: a systematic review and meta-analysis</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Huang</surname>
<given-names>Junmei</given-names>
</name>
<xref ref-type="corresp" rid="c001"><sup>&#x002A;</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/2728019/overview"/>
<role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/>
<role content-type="https://credit.niso.org/contributor-roles/methodology/"/>
<role content-type="https://credit.niso.org/contributor-roles/software/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Cheng</surname>
<given-names>Hao</given-names>
</name>
<role content-type="https://credit.niso.org/contributor-roles/data-curation/"/>
<role content-type="https://credit.niso.org/contributor-roles/software/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
</contrib-group>
<aff><institution>Department of Nutrition, Sanya Central Hospital (The Third People's Hospital of Hainan Province)</institution>, <addr-line>Sanya</addr-line>, <country>China</country></aff>
<author-notes>
<fn fn-type="edited-by" id="fn0001">
<p>Edited by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1837072/overview">Malgorzata Ziarno</ext-link>, Warsaw University of Life Sciences, Poland</p>
</fn>
<fn fn-type="edited-by" id="fn0002">
<p>Reviewed by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1621844/overview">Francesco Pizza</ext-link>, ASL Napoli 2 Nord, Italy</p>
<p><ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/2066110/overview">Chang Hong</ext-link>, Baotou Medical College, China</p>
<p><ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/3124585/overview">So Youn An</ext-link>, Wonkwang University, Republic of Korea</p>
</fn>
<corresp id="c001">&#x002A;Correspondence: Junmei Huang, <email>huangjm6783@163.com</email></corresp>
</author-notes>
<pub-date pub-type="epub">
<day>25</day>
<month>09</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="collection">
<year>2025</year>
</pub-date>
<volume>16</volume>
<elocation-id>1633434</elocation-id>
<history>
<date date-type="received">
<day>22</day>
<month>05</month>
<year>2025</year>
</date>
<date date-type="accepted">
<day>08</day>
<month>09</month>
<year>2025</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2025 Huang and Cheng.</copyright-statement>
<copyright-year>2025</copyright-year>
<copyright-holder>Huang and Cheng</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<sec id="sec1">
<title>Objective</title>
<p>This study endeavors to elucidate how <italic>Bifidobacteria</italic> supplementation affects metabolic parameters among overweight or obese populations.</p>
</sec>
<sec id="sec2">
<title>Methods</title>
<p>A systematic review and meta-analysis were carried out leveraging PubMed, Embase, Cochrane Library, and Web of Science. Merely randomized controlled trials (RCTs) were included.</p>
</sec>
<sec id="sec3">
<title>Results</title>
<p>21 RCTs were encompassed for our final analysis. <italic>Bifidobacteria</italic> supplementation was effective in weight management for overweight or obese patients. The experimental group receiving <italic>Bifidobacteria</italic> exhibited a marked decrease in weight (WMD: &#x2212;0.607 kg; 95% CI: &#x2212;0.910, &#x2212;0.303, <italic>I<sup>2</sup></italic> =&#x202F;11.9%) and BMI (WMD: &#x2212;0.214 kg/m<sup>2</sup>; 95% CI: &#x2212;0.259, &#x2212;0.169, <italic>I<sup>2</sup></italic> =&#x202F;4.1%) in contrast to the control, although the significant effect was not noted on WC. Moreover, while <italic>Bifidobacteria</italic> supplementation led to no marked drop in FBG or HbA1c, it improved the insulin (SMD: -0.268; 95% CI: &#x2212;0.470, &#x2212;0.066, <italic>I<sup>2</sup></italic> =&#x202F;5.4%). However, there were no evident variations in TC, TG, HDL-C, or LDL-C across groups.</p>
</sec>
<sec id="sec4">
<title>Conclusion</title>
<p>Our study findings confirmed that <italic>Bifidobacteria</italic> contributes to a slight reduction in weight and BMI among the overweight or obese populations, making it a potential adjunctive approach for weight management. Furthermore, it may help regulate insulin levels, though its impact on hyperglycemia and hyperlipidemia remains limited.</p>
</sec>
<sec id="sec2011">
<title>Systematic review registration</title>
<p><uri xlink:href="https://www.crd.york.ac.uk/PROSPERO">https://www.crd.york.ac.uk/PROSPERO</uri>. Registration No. CRD42025635324.</p>
</sec>
</abstract>
<kwd-group>
<kwd>
<italic>Bifidobacteria</italic>
</kwd>
<kwd>overweight or obesity</kwd>
<kwd>weight</kwd>
<kwd>blood glucose</kwd>
<kwd>blood lipids</kwd>
</kwd-group>
<counts>
<fig-count count="11"/>
<table-count count="2"/>
<equation-count count="0"/>
<ref-count count="48"/>
<page-count count="15"/>
<word-count count="7050"/>
</counts>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-at-acceptance</meta-name>
<meta-value>Microorganisms in Vertebrate Digestive Systems</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec sec-type="intro" id="sec5">
<label>1</label>
<title>Introduction</title>
<p>As the global obesity epidemic continues to intensify, overweight and obesity have become significant public health concerns worldwide (<xref ref-type="bibr" rid="ref13">GBD 2021 Adult BMI Collaborators, 2025</xref>). Obesity not only diminishes an individual&#x2019;s quality of life but is also strongly associated with various chronic diseases, such as cardiovascular diseases, type 2 diabetes mellitus (T2DM), certain cancers, and a range of metabolic disorders (<xref ref-type="bibr" rid="ref7">Bl&#x00FC;her, 2019</xref>). Consequently, identifying effective interventions for the prevention and treatment of obesity has become increasingly critical.</p>
<p>In recent, growing attention has been directed towards the relationship between the gut microbiota and obesity (<xref ref-type="bibr" rid="ref3">Asadi et al., 2022</xref>). The gut microbiota, an intricate ecosystem involving trillions of microorganisms, is crucial in host metabolism, immunity, as well as disease susceptibility (<xref ref-type="bibr" rid="ref14">Geng et al., 2022</xref>). Among these microorganisms, <italic>Bifidobacteria</italic>, an important component of the gut microbiota, has garnered particular attention due to its potential health benefits (<xref ref-type="bibr" rid="ref36">Sarita et al., 2024</xref>). <italic>Bifidobacteria</italic> are Gram-positive, anaerobic probiotics known to exert multiple positive effects on host health, including improving gut barrier function, modulating immune responses, and influencing energy metabolism (<xref ref-type="bibr" rid="ref2">Amabebe et al., 2020</xref>). Multiple studies have demonstrated that the abundance of <italic>Bifidobacterium</italic> in the gut of obese individuals is generally lower than that in healthy populations (<xref ref-type="bibr" rid="ref26">Leite et al., 2024</xref>; <xref ref-type="bibr" rid="ref15">Gong et al., 2022</xref>). This dysbiosis may be associated with high-fat diets, metabolic disturbances, and chronic inflammation (<xref ref-type="bibr" rid="ref19">Hills et al., 2019</xref>). Experimental evidence indicates that reduced <italic>Bifidobacterium</italic> abundance, accompanied by fat accumulation and inflammation, can be ameliorated by supplementation with specific <italic>Bifidobacterium</italic> strains, leading to attenuated weight gain and reduced fat deposition in obese mice (<xref ref-type="bibr" rid="ref49">Zha et al., 2024</xref>). Furthermore, <xref ref-type="bibr" rid="ref10">Da Silva et al. (2020)</xref> found that the proportion of <italic>Bifidobacterium</italic> in the gut microbiota of obese children was significantly lower than that of healthy counterparts. Some studies have suggested that the abundance of <italic>Bifidobacterium</italic> may be restored following bariatric surgery or dietary interventions (<xref ref-type="bibr" rid="ref38">Seganfredo et al., 2017</xref>). The potential mechanisms may involve metabolic regulation mediated by short-chain fatty acids (SCFAs). For example, acetate and propionate can activate G-protein-coupled receptors (GPR41/GPR43), thereby suppressing lipogenesis and promoting energy utilization (<xref ref-type="bibr" rid="ref46">Yun et al., 2024</xref>). Butyrate may stimulate the secretion of GLP-1 and PYY, reducing appetite through hormonal regulation (<xref ref-type="bibr" rid="ref20">Horiuchi et al., 2020</xref>). In addition, SCFAs can enhance AMP-activated protein kinase (AMPK) activity, thereby facilitating fatty acid <italic>&#x03B2;</italic>-oxidation and promoting fat catabolism. <italic>Bifidobacterium</italic> may also influence bile acid metabolism by activating farnesoid X receptor (FXR) and TGR5, thereby improving glucose and lipid metabolism (<xref ref-type="bibr" rid="ref21">Joyce and Gahan, 2016</xref>). Although studies have suggested that <italic>Bifidobacteria</italic> may be closely linked to weight management and glucose and lipid metabolic homeostasis in the population with excess weight or obesity, related findings show discrepancies, and a systematic evaluation and quantitative analysis are lacking. For instance, <xref ref-type="bibr" rid="ref4">Bai et al. (2024)</xref> proved that the short-chain <italic>Bifidobacterium</italic> BBr60 markedly lowered weight, body mass index (BMI), and FBG, and modulated lipid profiles safely and effectively. In contrast, <xref ref-type="bibr" rid="ref40">Sudha et al. (2019)</xref> found no significant changes in blood lipids or blood glucose levels. Additionally, some studies have indicated that yogurt containing <italic>Bifidobacteria</italic> does not produce significant changes in weight or BMI in overweight or obese populations.</p>
<p>However, the evidence remains inconsistent. Some trials have demonstrated beneficial effects of <italic>Bifidobacteria</italic> supplementation on weight, glucose, and lipid metabolism, while other studies report negligible or no benefits. To date, no comprehensive quantitative synthesis has been performed to resolve these discrepancies. Therefore, this study seeks to unveil the effects of <italic>Bifidobacteria</italic> supplementation on metabolic parameters within individuals with excess weight or obesity based on randomized controlled trials (RCTs) via systematic review and meta-analysis.</p>
</sec>
<sec sec-type="methods" id="sec6">
<label>2</label>
<title>Methods</title>
<sec id="sec7">
<label>2.1</label>
<title>Registration and PRISMA statement</title>
<p>This review complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was prospectively registered in PROSPERO (Registration No. CRD42025635324) (<xref ref-type="bibr" rid="ref32">Page et al., 2021</xref>).</p>
</sec>
<sec id="sec8">
<label>2.2</label>
<title>Literature search</title>
<sec id="sec9">
<label>2.2.1</label>
<title>Data sources and search scope</title>
<p>A comprehensive literature search was performed in four online databases (PubMed, Embase, Cochrane Library, and Web of Science) to identify RCTs. The search covered the period from database inception to December 3, 2024. Keywords such as &#x201C;<italic>Bifidobacterium</italic>,&#x201D; &#x201C;obesity,&#x201D; and &#x201C;overweight&#x201D; were used as both subject terms and free words in the search. The search strategy is presented in <xref ref-type="table" rid="tab1">Table 1</xref>. The references of prior systematic reviews were also checked for eligible RCTs.</p>
<table-wrap position="float" id="tab1">
<label>Table 1</label>
<caption>
<p>Search strategy and results.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="top" colspan="3">Pubmed</th>
</tr>
<tr>
<th align="left" valign="top">#</th>
<th align="left" valign="top">Query</th>
<th align="center" valign="top">Results</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top">1</td>
<td align="left" valign="top">Overweight[MeSH Terms]</td>
<td align="center" valign="top">289,803</td>
</tr>
<tr>
<td align="left" valign="top">2</td>
<td align="left" valign="top">Obesity[MeSH Terms]</td>
<td align="center" valign="top">277,956</td>
</tr>
<tr>
<td align="left" valign="top">3</td>
<td align="left" valign="top">&#x2018;adipose tissue hyperplasia&#x2019;[Title/Abstract] OR &#x2018;adipositas&#x2019;[Title/Abstract] OR &#x2018;adiposity&#x2019;[Title/Abstract] OR &#x2018;alimentary obesity&#x2019;[Title/Abstract] OR &#x2018;body weight, excess&#x2019;[Title/Abstract] OR &#x2018;corpulency&#x2019;[Title/Abstract] OR &#x2018;fat overload syndrome&#x2019;[Title/Abstract] OR &#x2018;nutritional obesity&#x2019;[Title/Abstract] OR &#x2018;obesitas&#x2019;[Title/Abstract] OR &#x2018;obesity&#x2019;[Title/Abstract] OR &#x2018;overweight&#x2019;[Title/Abstract]</td>
<td align="center" valign="top">406,017</td>
</tr>
<tr>
<td align="left" valign="top">4</td>
<td align="left" valign="top">Bifidobacterium[MeSH Terms]</td>
<td align="center" valign="top">7,796</td>
</tr>
<tr>
<td align="left" valign="top">5</td>
<td align="left" valign="top">Bifidobacterium[Title/Abstract]</td>
<td align="center" valign="top">14,126</td>
</tr>
<tr>
<td align="left" valign="top">6</td>
<td align="left" valign="top">(#1 OR #2 OR #3) AND (#4 OR #5)</td>
<td align="center" valign="top">873</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="sec10">
<label>2.2.2</label>
<title>Eligibility criteria</title>
<p>Inclusion criteria: (1) Adults (&#x2265;18) diagnosed by a physician with overweight (BMI 25&#x2013;29.9&#x202F;kg/m<sup>2</sup>) or obesity (BMI 30&#x2013;34.9&#x202F;kg/m<sup>2</sup>); (2) Explicit use of Bifidobacterium as an intervention; (3) A control group receiving either a placebo or another type of intervention not involving <italic>Bifidobacterium</italic>, with all other conditions equivalent to the experimental group, ensuring comparability (e.g., routine care or blank control); (4) Outcome measures including anthropometric measurements, blood glucose, or lipid laboratory result; (5) Randomized controlled trials (RCTs). Exclusion criteria: (1) Duplicates, systematic reviews, and meta-analyses; (2) Literature reviews, case reports, non-English publications, animal studies, letters to the editor, and narrative reviews; (3) Full texts were inaccessible, data could not be extracted, or the studies were ineligible.</p>
</sec>
<sec id="sec11">
<label>2.2.3</label>
<title>Literature screening and data extraction</title>
<p>Two researchers independently filtered the literature, collected related data, and assessed study quality. EndNote was utilized during the screening process. The extracted data encompassed bibliographic information (authors, publication year, country), study characteristics (sample size, bacterial strains, study outcomes), and participant characteristics (age, BMI). Data extraction was conducted utilizing Excel. Dissents were addressed via discussion or consultation with a third researcher.</p>
</sec>
<sec id="sec12">
<label>2.2.4</label>
<title>Outcome measures</title>
<p>The primary outcomes assessed in this meta-analysis were: weight, BMI, as well as waist circumference (WC). Secondary outcomes encompassed fasting blood glucose (FBG), glycated hemoglobin (HbA1c), insulin, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C).</p>
</sec>
</sec>
<sec id="sec13">
<label>2.3</label>
<title>Risk of bias assessment</title>
<p>The risk of bias was rated independently by two reviewers. Dissents were addressed after discussion or judgment of a third party. Concerning quality assessment, both reviewers used the NIH RCT Quality Assessment Tool for study quality evaluation. There were 14 items, each assessed as &#x201C;Yes&#x201D; or &#x201C;No&#x201D; based on the study&#x2019;s design and implementation standards (<xref ref-type="bibr" rid="ref31">NIH, n.d.</xref>). In case of discrepancies during the evaluation, a third researcher was consulted to ensure fairness and consistency. Studies were rated for potential bias via a scoring scale, with three distinct categories: high risk (0&#x2013;5, poor), moderate risk (6&#x2013;10, fair), and low risk (11&#x2013;14, good).</p>
</sec>
<sec id="sec14">
<label>2.4</label>
<title>Statistical analysis</title>
<p>Data analysis was enabled by Stata MP 15. Continuous data were shown in standardized mean difference (SMD) or mean difference (MD). An SMD of &#x003C; 0.2 indicates a negligible difference between groups, whereas a value ranging from 0.2 to 0.49 suggests a small difference. A value between 0.5 and 0.79 represents a moderate difference, and a value &#x2265; 0.8 denotes a substantial difference across groups. For dichotomous data, the risk ratio (RR) and its 95% confidence interval (CI) were computed. Heterogeneity was detected via the <italic>I<sup>2</sup></italic> statistic and the Q-test. When the <italic>I<sup>2</sup></italic> value exceeded 50% and the <italic>p</italic>&#x202F;&#x003C;&#x202F;0.05, a random-effects model was applied; otherwise, a fixed-effects model was used. The robustness of our results was rated through sensitivity analyses. For meta-analyses involving over 10 studies, possible publication bias was examined utilizing funnel plots and Egger&#x2019;s test. In cases of bias, the effect on the results was evaluated through the trim-and-fill approach.</p>
</sec>
</sec>
<sec sec-type="results" id="sec15">
<label>3</label>
<title>Results</title>
<sec id="sec16">
<label>3.1</label>
<title>Literature search results</title>
<p>Based on the predefined search strategy, a preliminary search of the databases identified 4,105 articles. After screening titles and abstracts, 922 duplicate entries were excluded, resulting in 3,159 articles being discarded. The remaining 28 articles were subjected to full-text review. Four articles were excluded owing to unavailable full texts, two owing to the inability to extract data, and one due to failure to meet the inclusion criteria. Ultimately, 21 eligible RCTs were included, as shown in <xref ref-type="fig" rid="fig1">Figure 1</xref>.</p>
<fig position="float" id="fig1">
<label>Figure 1</label>
<caption>
<p>Study screening flowchart.</p>
</caption>
<graphic xlink:href="fmicb-16-1633434-g001.tif" mimetype="image" mime-subtype="tiff">
<alt-text content-type="machine-generated">Flowchart illustrating the identification of studies via databases. Records identified from Pubmed (873), Cochrane (334), Embase (1515), Web of Science (1383) total 4105. After removing 922 duplicates, 3183 records are screened. Out of 3183, 28 reports are sought for retrieval, with 4 not retrieved. Twenty-four reports are assessed for eligibility; 3 are excluded due to data extraction issues or research mismatch. Ultimately, 21 studies are included in the review.</alt-text>
</graphic>
</fig>
</sec>
<sec id="sec17">
<label>3.2</label>
<title>Study characteristics</title>
<p>The baseline characteristics of the 21 included RCTs are summarized in <xref ref-type="table" rid="tab2">Table 2</xref>. Of these, 13 (<xref ref-type="bibr" rid="ref4">Bai et al., 2024</xref>; <xref ref-type="bibr" rid="ref40">Sudha et al., 2019</xref>; <xref ref-type="bibr" rid="ref1">AlMalki et al., 2024</xref>; <xref ref-type="bibr" rid="ref5">Banach and Jedut, 2020</xref>; <xref ref-type="bibr" rid="ref17">Hadi et al., 2019</xref>; <xref ref-type="bibr" rid="ref22">Kanazawa et al., 2021</xref>; <xref ref-type="bibr" rid="ref25">Lauw et al., 2023</xref>; <xref ref-type="bibr" rid="ref30">Minami et al., 2015</xref>; <xref ref-type="bibr" rid="ref37">Sato et al., 2024</xref>; <xref ref-type="bibr" rid="ref41">Tajabadi-Ebrahimi et al., 2017</xref>; <xref ref-type="bibr" rid="ref45">Wu et al., 2024</xref>; <xref ref-type="bibr" rid="ref47">Zarrati et al., 2019</xref>; <xref ref-type="bibr" rid="ref48">Zarrati et al., 2014</xref>) were conducted in Asian countries, 6 (<xref ref-type="bibr" rid="ref18">Hibberd et al., 2019</xref>; <xref ref-type="bibr" rid="ref23">Kobyliak et al., 2018</xref>; <xref ref-type="bibr" rid="ref24">Kopp et al., 2023</xref>; <xref ref-type="bibr" rid="ref28">Majewska et al., 2020</xref>; <xref ref-type="bibr" rid="ref29">Michael et al., 2021</xref>; <xref ref-type="bibr" rid="ref33">Parascinet et al., 2023</xref>) in European countries, and 2 (<xref ref-type="bibr" rid="ref9">Crovesy et al., 2021</xref>; <xref ref-type="bibr" rid="ref39">Sergeev et al., 2020</xref>) in the United States and Brazil, respectively. The studies were published between 2014 and 2024 and collectively enrolled 1,392 participants. All studies used BMI as the indicator for overweight or obesity. According to the World Health Organization&#x2019;s classification (<xref ref-type="bibr" rid="ref43">WHO, 2024</xref>), overweight was defined as a BMI between 25 and 29.9&#x202F;kg/m<sup>2</sup>, while obesity was confirmed by a BMI of 30&#x202F;kg/m<sup>2</sup> or higher. 8 studies (<xref ref-type="bibr" rid="ref4">Bai et al., 2024</xref>; <xref ref-type="bibr" rid="ref40">Sudha et al., 2019</xref>; <xref ref-type="bibr" rid="ref22">Kanazawa et al., 2021</xref>; <xref ref-type="bibr" rid="ref30">Minami et al., 2015</xref>; <xref ref-type="bibr" rid="ref45">Wu et al., 2024</xref>; <xref ref-type="bibr" rid="ref47">Zarrati et al., 2019</xref>; <xref ref-type="bibr" rid="ref48">Zarrati et al., 2014</xref>; <xref ref-type="bibr" rid="ref33">Parascinet et al., 2023</xref>) reported the use of <italic>Bifidobacterium breve</italic>, three studies (<xref ref-type="bibr" rid="ref17">Hadi et al., 2019</xref>; <xref ref-type="bibr" rid="ref41">Tajabadi-Ebrahimi et al., 2017</xref>; <xref ref-type="bibr" rid="ref29">Michael et al., 2021</xref>) used <italic>Bifidobacterium longum</italic>, five studies (<xref ref-type="bibr" rid="ref37">Sato et al., 2024</xref>; <xref ref-type="bibr" rid="ref23">Kobyliak et al., 2018</xref>; <xref ref-type="bibr" rid="ref28">Majewska et al., 2020</xref>; <xref ref-type="bibr" rid="ref39">Sergeev et al., 2020</xref>; <xref ref-type="bibr" rid="ref1">AlMalki et al., 2024</xref>) used a mixed <italic>Bifidobacterium</italic> species, two studies (<xref ref-type="bibr" rid="ref5">Banach and Jedut, 2020</xref>; <xref ref-type="bibr" rid="ref18">Hibberd et al., 2019</xref>) used <italic>Bifidobacterium animalis</italic>, and three studies (<xref ref-type="bibr" rid="ref25">Lauw et al., 2023</xref>; <xref ref-type="bibr" rid="ref24">Kopp et al., 2023</xref>; <xref ref-type="bibr" rid="ref9">Crovesy et al., 2021</xref>) used <italic>Bifidobacterium lactis</italic>. The NIH quality assessment indicated that 11 studies (<xref ref-type="bibr" rid="ref4">Bai et al., 2024</xref>; <xref ref-type="bibr" rid="ref1">AlMalki et al., 2024</xref>; <xref ref-type="bibr" rid="ref37">Sato et al., 2024</xref>; <xref ref-type="bibr" rid="ref41">Tajabadi-Ebrahimi et al., 2017</xref>; <xref ref-type="bibr" rid="ref45">Wu et al., 2024</xref>; <xref ref-type="bibr" rid="ref47">Zarrati et al., 2019</xref>; <xref ref-type="bibr" rid="ref48">Zarrati et al., 2014</xref>; <xref ref-type="bibr" rid="ref23">Kobyliak et al., 2018</xref>; <xref ref-type="bibr" rid="ref28">Majewska et al., 2020</xref>; <xref ref-type="bibr" rid="ref29">Michael et al., 2021</xref>; <xref ref-type="bibr" rid="ref9">Crovesy et al., 2021</xref>) had low risk of bias, while 10 studies (<xref ref-type="bibr" rid="ref40">Sudha et al., 2019</xref>; <xref ref-type="bibr" rid="ref5">Banach and Jedut, 2020</xref>; <xref ref-type="bibr" rid="ref22">Kanazawa et al., 2021</xref>; <xref ref-type="bibr" rid="ref25">Lauw et al., 2023</xref>; <xref ref-type="bibr" rid="ref30">Minami et al., 2015</xref>; <xref ref-type="bibr" rid="ref18">Hibberd et al., 2019</xref>; <xref ref-type="bibr" rid="ref24">Kopp et al., 2023</xref>; <xref ref-type="bibr" rid="ref33">Parascinet et al., 2023</xref>; <xref ref-type="bibr" rid="ref9">Crovesy et al., 2021</xref>; <xref ref-type="bibr" rid="ref39">Sergeev et al., 2020</xref>) exhibited moderate risk of bias, as detailed in <xref rid="SM1" ref-type="supplementary-material">Supplementary Table 1</xref>.</p>
<table-wrap position="float" id="tab2">
<label>Table 2</label>
<caption>
<p>Characteristics of studies selected and included in the meta-analysis.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="top">Study</th>
<th align="center" valign="top">Year</th>
<th align="left" valign="top">Country</th>
<th align="center" valign="top">Sample size</th>
<th align="center" valign="top">Age (Y)</th>
<th align="center" valign="top">BMI (mean&#x00B1; SD)</th>
<th align="left" valign="top">Overweight or obese status</th>
<th align="left" valign="top">Comorbidities</th>
<th align="left" valign="top">Bifidobacterium strains</th>
<th align="center" valign="top">Quantity of strains (CFU/day)</th>
<th align="center" valign="top">Frequency (times/day)</th>
<th align="left" valign="top">Administration time</th>
<th align="center" valign="top">Duration (week)</th>
<th align="left" valign="top">Control Group</th>
<th align="left" valign="top">Outcomes</th>
<th align="center" valign="top">NIH</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref1">AlMalki et al. (2024)</xref>
</td>
<td align="center" valign="top">2024</td>
<td align="left" valign="top">King Saud</td>
<td align="center" valign="top">93</td>
<td align="center" valign="top">19&#x2013;40</td>
<td align="center" valign="top">30.8&#x202F;&#x00B1;&#x202F;2.8</td>
<td align="left" valign="top">Overweight or obese</td>
<td align="left" valign="top">No</td>
<td align="left" valign="top">Three bifidobacterium species</td>
<td align="center" valign="top">30&#x202F;&#x00D7;&#x202F;10<sup>9</sup></td>
<td align="center" valign="top">2</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">12</td>
<td align="left" valign="top">Placebo</td>
<td align="left" valign="top">Weight, BMI, WC, FPG, HbA1c, TC, HDL-C, LDL-C</td>
<td align="center" valign="top">14</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref4">Bai et al. (2024)</xref>
</td>
<td align="center" valign="top">2024</td>
<td align="left" valign="top">China</td>
<td align="center" valign="top">75</td>
<td align="center" valign="top">19&#x2013;45</td>
<td align="center" valign="top">31.4&#x202F;&#x00B1;&#x202F;3.1</td>
<td align="left" valign="top">Overweight or obese</td>
<td align="left" valign="top">No</td>
<td align="left" valign="top"><italic>Bifidobacterium breve</italic></td>
<td align="center" valign="top">10<sup>10</sup></td>
<td align="center" valign="top">1</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">12</td>
<td align="left" valign="top">Placebo</td>
<td align="left" valign="top">Weight, BMI, FPG, TC, TG, HDL-C, LDL-C</td>
<td align="center" valign="top">12</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref5">Banach and Jedut (2020)</xref>
</td>
<td align="center" valign="top">2020</td>
<td align="left" valign="top">China</td>
<td align="center" valign="top">54</td>
<td align="center" valign="top">20&#x2013;49</td>
<td align="center" valign="top">34.9&#x202F;&#x00B1;&#x202F;3.9</td>
<td align="left" valign="top">Obese</td>
<td align="left" valign="top">No</td>
<td align="left" valign="top"><italic>Bifidobacterium animalis</italic> subsp</td>
<td align="center" valign="top">NI</td>
<td align="center" valign="top">1</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">12</td>
<td align="left" valign="top">The same diet group without probiotics</td>
<td align="left" valign="top">Weight, BMI</td>
<td align="center" valign="top">9</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref9">Crovesy et al. (2021)</xref>
</td>
<td align="center" valign="top">2021</td>
<td align="left" valign="top">Brazil</td>
<td align="center" valign="top">32</td>
<td align="center" valign="top">19&#x2013;40</td>
<td align="center" valign="top">35.0&#x202F;&#x00B1;&#x202F;7.5</td>
<td align="left" valign="top">Obese</td>
<td align="left" valign="top">No</td>
<td align="left" valign="top"><italic>Bifidobacterium lactis</italic></td>
<td align="center" valign="top">10<sup>9</sup></td>
<td align="center" valign="top">1</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">8</td>
<td align="left" valign="top">No specific treatment</td>
<td align="left" valign="top">Weight, BMI, WC</td>
<td align="center" valign="top">6</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref17">Hadi et al. (2019)</xref>
</td>
<td align="center" valign="top">2019</td>
<td align="left" valign="top">Iran</td>
<td align="center" valign="top">60</td>
<td align="center" valign="top">20&#x2013;65</td>
<td align="center" valign="top">30.9&#x202F;&#x00B1;&#x202F;3.5</td>
<td align="left" valign="top">Overweight or obese</td>
<td align="left" valign="top">No</td>
<td align="left" valign="top"><italic>Bifidobacterium bifidum</italic></td>
<td align="center" valign="top">2&#x202F;&#x00D7;&#x202F;10<sup>9</sup></td>
<td align="center" valign="top">1</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">8</td>
<td align="left" valign="top">Placebo</td>
<td align="left" valign="top">Weight, BMI, WC, FPG, TC, TG, LDL-C, HDL-C,</td>
<td align="center" valign="top">11</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref18">Hibberd et al. (2019)</xref>
</td>
<td align="center" valign="top">2019</td>
<td align="left" valign="top">Finland</td>
<td align="center" valign="top">134</td>
<td align="center" valign="top">20&#x2013;49</td>
<td align="center" valign="top">31.1&#x202F;&#x00B1;&#x202F;1.9</td>
<td align="left" valign="top">Overweight or obese</td>
<td align="left" valign="top">No</td>
<td align="left" valign="top"><italic>Bifidobacterium animalis</italic> subsp.</td>
<td align="center" valign="top">10<sup>10</sup></td>
<td align="center" valign="top">1</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">24</td>
<td align="left" valign="top">Placebo</td>
<td align="left" valign="top">Weight, BMI, WC, HbA1c, Insulin, TC, TG, HDL-C, LDL-C</td>
<td align="center" valign="top">8</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref22">Kanazawa et al. (2021)</xref>
</td>
<td align="center" valign="top">2021</td>
<td align="left" valign="top">Japan</td>
<td align="center" valign="top">88</td>
<td align="center" valign="top">30&#x2013;80</td>
<td align="center" valign="top">29.3&#x202F;&#x00B1;&#x202F;4.1</td>
<td align="left" valign="top">Overweight or obese</td>
<td align="left" valign="top">T2DM</td>
<td align="left" valign="top"><italic>Bifidobacterium breve</italic></td>
<td align="center" valign="top">3&#x00D7;10<sup>8</sup></td>
<td align="center" valign="top">2</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">24</td>
<td align="left" valign="top">Control group without probiotics</td>
<td align="left" valign="top">BMI, FPG, HbA1c, TC, TG, HDL-C</td>
<td align="center" valign="top">6</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref23">Kobyliak et al. (2018)</xref>
</td>
<td align="center" valign="top">2018</td>
<td align="left" valign="top">Ukraine</td>
<td align="center" valign="top">53</td>
<td align="center" valign="top">18&#x2013;75</td>
<td align="center" valign="top">35.1&#x202F;&#x00B1;&#x202F;1.48</td>
<td align="left" valign="top">Obese</td>
<td align="left" valign="top">T2DM</td>
<td align="left" valign="top">Bifidobacterium</td>
<td align="center" valign="top">10<sup>10</sup></td>
<td align="center" valign="top">1</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">8</td>
<td align="left" valign="top">Placebo</td>
<td align="left" valign="top">Weight, BMI, WC, FPG, HbA1c, Insulin</td>
<td align="center" valign="top">14</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref24">Kopp et al. (2023)</xref>
</td>
<td align="center" valign="top">2023</td>
<td align="left" valign="top">Germany</td>
<td align="center" valign="top">76</td>
<td align="center" valign="top">25&#x2013;65</td>
<td align="center" valign="top">34.3&#x202F;&#x00B1;&#x202F;3.3</td>
<td align="left" valign="top">Obese</td>
<td align="left" valign="top">No</td>
<td align="left" valign="top">bifidobacterium lactis</td>
<td align="center" valign="top">1.25&#x202F;&#x00D7;&#x202F;10<sup>9</sup></td>
<td align="center" valign="top">1</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">8</td>
<td align="left" valign="top">Placebo</td>
<td align="left" valign="top">Weight, BMI, InsulinP</td>
<td align="center" valign="top">9</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref25">Lauw et al. (2023)</xref>
</td>
<td align="center" valign="top">2023</td>
<td align="left" valign="top">China</td>
<td align="center" valign="top">55</td>
<td align="center" valign="top">20&#x2013;65</td>
<td align="center" valign="top">29.3&#x202F;&#x00B1;&#x202F;4.0</td>
<td align="left" valign="top">Overweight or obese</td>
<td align="left" valign="top">No</td>
<td align="left" valign="top"><italic>Bifidobacterium lactis</italic></td>
<td align="center" valign="top">5&#x202F;&#x00D7;&#x202F;10<sup>9</sup></td>
<td align="center" valign="top">2</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">8</td>
<td align="left" valign="top">Dietary intervention group</td>
<td align="left" valign="top">Weight, BMI, Insulin, TC, TG, HDL-C</td>
<td align="center" valign="top">7</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref28">Majewska et al. (2020)</xref>
</td>
<td align="center" valign="top">2020</td>
<td align="left" valign="top">Poland</td>
<td align="center" valign="top">50</td>
<td align="center" valign="top">45&#x2013;70</td>
<td align="center" valign="top">36.4&#x202F;&#x00B1;&#x202F;5.2</td>
<td align="left" valign="top">Obese</td>
<td align="left" valign="top">No</td>
<td align="left" valign="top"><italic>Bifidobacterium bifidum</italic>, <italic>Bifidobacterium lactis</italic></td>
<td align="center" valign="top">2.5&#x202F;&#x00D7;&#x202F;10 <sup>9</sup></td>
<td align="center" valign="top">1</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">12</td>
<td align="left" valign="top">Placebo</td>
<td align="left" valign="top">TC, TG, HDL-C, LDL-C</td>
<td align="center" valign="top">11</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref29">Michael et al. (2021)</xref>
</td>
<td align="center" valign="top">2021</td>
<td align="left" valign="top">Bulgaria</td>
<td align="center" valign="top">70</td>
<td align="center" valign="top">45&#x2013;65</td>
<td align="center" valign="top">28&#x202F;&#x00B1;&#x202F;1.5</td>
<td align="left" valign="top">Overweigh</td>
<td align="left" valign="top">No</td>
<td align="left" valign="top">Bifdobacterium bifdum</td>
<td align="center" valign="top">5&#x202F;&#x00D7;&#x202F;10<sup>10</sup></td>
<td align="center" valign="top">1</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">12</td>
<td align="left" valign="top">Placebo</td>
<td align="left" valign="top">Weight, BMI, WC</td>
<td align="center" valign="top">13</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref30">Minami et al. (2015)</xref>
</td>
<td align="center" valign="top">2015</td>
<td align="left" valign="top">Japan</td>
<td align="center" valign="top">52</td>
<td align="center" valign="top">40&#x2013;69</td>
<td align="center" valign="top">27.4&#x202F;&#x00B1;&#x202F;0.6</td>
<td align="left" valign="top">Overweigh</td>
<td align="left" valign="top">No</td>
<td align="left" valign="top"><italic>Bifidobacterium breve</italic></td>
<td align="center" valign="top">5&#x202F;&#x00D7;&#x202F;10<sup>10</sup></td>
<td align="center" valign="top">1</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">12</td>
<td align="left" valign="top">Placebo</td>
<td align="left" valign="top">Weight, BMI, FPG, HbA1c, Insulin</td>
<td align="center" valign="top">9</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref33">Parascinet et al. (2023)</xref>
</td>
<td align="center" valign="top">2023</td>
<td align="left" valign="top">Spain</td>
<td align="center" valign="top">20</td>
<td align="center" valign="top">&#x2265;18</td>
<td align="center" valign="top">&#x2265;30</td>
<td align="left" valign="top">obese</td>
<td align="left" valign="top">No</td>
<td align="left" valign="top"><italic>Bifidobacterium breve</italic></td>
<td align="center" valign="top">10<sup>9</sup></td>
<td align="center" valign="top">1</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">10</td>
<td align="left" valign="top">Control group</td>
<td align="left" valign="top">FPG, HbA1c, TC, TG, HDL-C, LDL-C</td>
<td align="center" valign="top">9</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref37">Sato et al. (2024)</xref>
</td>
<td align="center" valign="top">2024</td>
<td align="left" valign="top">Japan</td>
<td align="center" valign="top">100</td>
<td align="center" valign="top">20&#x2013;64</td>
<td align="center" valign="top">26.1&#x202F;&#x00B1;&#x202F;1.8</td>
<td align="left" valign="top">Overweight</td>
<td align="left" valign="top">No</td>
<td align="left" valign="top"><italic>Bifidobacterium longum</italic>, <italic>Bifidobacterium breve</italic></td>
<td align="center" valign="top">1&#x202F;&#x00D7;&#x202F;10<sup>10</sup> and 5&#x202F;&#x00D7;&#x202F;10<sup>10</sup></td>
<td align="center" valign="top">2</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">16</td>
<td align="left" valign="top">Placebo</td>
<td align="left" valign="top">Weight, BMI, TG</td>
<td align="center" valign="top">12</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref39">Sergeev et al. (2020)</xref>
</td>
<td align="center" valign="top">2020</td>
<td align="left" valign="top">America</td>
<td align="center" valign="top">20</td>
<td align="center" valign="top">30&#x2013;65</td>
<td align="center" valign="top">33.5&#x202F;&#x00B1;&#x202F;5.0</td>
<td align="left" valign="top">Obese</td>
<td align="left" valign="top">No</td>
<td align="left" valign="top"><italic>Bifidobacterium lactis</italic>, <italic>Bifidobacterium longum</italic>, <italic>Bifidobacterium bifidum</italic></td>
<td align="center" valign="top">15&#x202F;&#x00D7;&#x202F;10<sup>10</sup></td>
<td align="center" valign="top">1</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">12</td>
<td align="left" valign="top">Placebo</td>
<td align="left" valign="top">Weight, BMI, WC, HbA1c</td>
<td align="center" valign="top">9</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref40">Sudha et al. (2019)</xref>
</td>
<td align="center" valign="top">2019</td>
<td align="left" valign="top">India</td>
<td align="center" valign="top">71</td>
<td align="center" valign="top">30&#x2013;65</td>
<td align="center" valign="top">27.6&#x202F;&#x00B1;&#x202F;2.2</td>
<td align="left" valign="top">Overweight</td>
<td align="left" valign="top">No</td>
<td align="left" valign="top"><italic>Bifidobacterium breve</italic></td>
<td align="center" valign="top">5&#x202F;&#x00D7;&#x202F;10<sup>9</sup></td>
<td align="center" valign="top">1</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">12</td>
<td align="left" valign="top">Placebo</td>
<td align="left" valign="top">Weight, BMI, FPG, TC, TG, HDL-C</td>
<td align="center" valign="top">9</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref41">Tajabadi-Ebrahimi et al. (2017)</xref>
</td>
<td align="center" valign="top">2016</td>
<td align="left" valign="top">King Saud</td>
<td align="center" valign="top">60</td>
<td align="center" valign="top">40&#x2013;85</td>
<td align="center" valign="top">31.0&#x202F;&#x00B1;&#x202F;5.5</td>
<td align="left" valign="top">Overweight or obese</td>
<td align="left" valign="top">T2DM</td>
<td align="left" valign="top"><italic>Bifidobacterium bifidum</italic></td>
<td align="center" valign="top">2&#x202F;&#x00D7;&#x202F;10<sup>9</sup></td>
<td align="center" valign="top">1</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">12</td>
<td align="left" valign="top">Placebo</td>
<td align="left" valign="top">Weight, BMI, FPG, Insulin, TC, TG, HDL-C, LDL-C</td>
<td align="center" valign="top">11</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref45">Wu et al. (2024)</xref>
</td>
<td align="center" valign="top">2024</td>
<td align="left" valign="top">China</td>
<td align="center" valign="top">75</td>
<td align="center" valign="top">19&#x2013;45</td>
<td align="center" valign="top">31.4&#x202F;&#x00B1;&#x202F;3.1</td>
<td align="left" valign="top">Overweight or obese</td>
<td align="left" valign="top">No</td>
<td align="left" valign="top"><italic>Bifidobacterium breve</italic></td>
<td align="center" valign="top">10<sup>10</sup></td>
<td align="center" valign="top">1</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">12</td>
<td align="left" valign="top">Placebo</td>
<td align="left" valign="top">Weight, BMI, FPG, TC, TG, HDL-C, LDL-C</td>
<td align="center" valign="top">11</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref47">Zarrati et al. (2019)</xref>
</td>
<td align="center" valign="top">2018</td>
<td align="left" valign="top">Iran</td>
<td align="center" valign="top">60</td>
<td align="center" valign="top">20&#x2013;50</td>
<td align="center" valign="top">32.1&#x202F;&#x00B1;&#x202F;4.4</td>
<td align="left" valign="top">Overweight or obese</td>
<td align="left" valign="top">No</td>
<td align="left" valign="top"><italic>Bifidobacterium bifidum</italic></td>
<td align="center" valign="top">10 <sup>8</sup></td>
<td align="center" valign="top">2</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">8</td>
<td align="left" valign="top">Conventional yogurt group</td>
<td align="left" valign="top">Weight, BMI, WC</td>
<td align="center" valign="top">11</td>
</tr>
<tr>
<td align="left" valign="top">
<xref ref-type="bibr" rid="ref48">Zarrati et al. (2014)</xref>
</td>
<td align="center" valign="top">2014</td>
<td align="left" valign="top">Iran</td>
<td align="center" valign="top">75</td>
<td align="center" valign="top">20&#x2013;50</td>
<td align="center" valign="top">33.9&#x202F;&#x00B1;&#x202F;6.5</td>
<td align="left" valign="top">Overweight or obese</td>
<td align="left" valign="top">No</td>
<td align="left" valign="top"><italic>Bifidobacterium bifidum</italic></td>
<td align="center" valign="top">10 <sup>7</sup></td>
<td align="center" valign="top">1</td>
<td align="left" valign="top">Week 1</td>
<td align="center" valign="top">8</td>
<td align="left" valign="top">Regular yogurt group</td>
<td align="left" valign="top">Weight, BMI, WC</td>
<td align="center" valign="top">12</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<p>BMI, body mass index; WC, waist circumference; FBG, fasting blood glucose; HbA1c, glycated hemoglobin; TC, total cholesterol; TG, triglyceride; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol.</p>
</table-wrap-foot>
</table-wrap>
</sec>
<sec id="sec18">
<label>3.3</label>
<title>Primary outcomes</title>
<sec id="sec19">
<label>3.3.1</label>
<title>Effects of <italic>Bifidobacterium</italic> on weight management</title>
<p>Eighteen studies reported on the relationship between <italic>Bifidobacterium</italic> supplementation and weight change. Sensitivity analysis demonstrated that the study conducted by Kobyliak had a considerable impact on the overall findings, as illustrated in <xref rid="SM1" ref-type="supplementary-material">Supplementary Figure 1</xref>. Upon exclusion of this study, the experimental group receiving <italic>Bifidobacterium</italic> supplementation showed a significantly greater reduction in body weight compared to the control group (WMD: &#x2212;0.607&#x202F;kg; 95% CI: &#x2212;0.910,&#x2013;0.303; <italic>I<sup>2</sup></italic> =&#x202F;11.9%), as shown in <xref ref-type="fig" rid="fig2">Figure 2</xref>. Funnel plot symmetry and the Egger test (<italic>p</italic>&#x202F;=&#x202F;0.804) suggested no significant publication bias, as presented in <xref rid="SM1" ref-type="supplementary-material">Supplementary Figure 2</xref>.</p>
<fig position="float" id="fig2">
<label>Figure 2</label>
<caption>
<p>Forest plot for weight.</p>
</caption>
<graphic xlink:href="fmicb-16-1633434-g002.tif" mimetype="image" mime-subtype="tiff">
<alt-text content-type="machine-generated">Forest plot showing weighted mean differences (WMD) with 95% confidence intervals (CI) for multiple studies. Each line represents a study with its WMD, CI, and percentage weight. The overall effect is summarized at the bottom, indicated by a diamond shape. Horizontal lines show confidence intervals for each study.</alt-text>
</graphic>
</fig>
<p>19 studies explored how <italic>Bifidobacterium</italic> supplementation influences BMI. Our meta-analysis demonstrated a notably larger BMI decline in the experimental group relative to the control (WMD: &#x2212;0.214 kg/m<sup>2</sup>; 95% CI: &#x2212;0.259, &#x2212;0.169, <italic>I<sup>2</sup></italic> =&#x202F;4.1%) (<xref ref-type="fig" rid="fig3">Figure 3</xref>). Eight studies examined the impact of <italic>Bifidobacterium</italic> on WC, but the difference across groups was insignificant (WMD: &#x2212;0.353 cm; 95% CI: &#x2212;0.759, &#x2212;0.053, <italic>I<sup>2</sup></italic> =&#x202F;88.3%) (<xref ref-type="fig" rid="fig4">Figure 4</xref>). Sensitivity analyses for BMI and WC indicated robust results, as shown in <xref rid="SM1" ref-type="supplementary-material">Supplementary Figures 3, 4</xref>. Both the funnel plot and Egger&#x2019;s test (<italic>p</italic>&#x202F;=&#x202F;0.867) demonstrated no discernible publication bias (<xref rid="SM1" ref-type="supplementary-material">Supplementary Figure 5</xref>).</p>
<fig position="float" id="fig3">
<label>Figure 3</label>
<caption>
<p>Forest plot for BMI.</p>
</caption>
<graphic xlink:href="fmicb-16-1633434-g003.tif" mimetype="image" mime-subtype="tiff">
<alt-text content-type="machine-generated">Forest plot showing the weighted mean differences (WMD) and 95% confidence intervals (CI) for various studies, highlighting individual study results as black diamonds and their CIs as horizontal lines. The overall effect is represented by a blue diamond at the bottom, indicating a WMD of -0.21 with a CI of -0.26 to -0.17. The vertical line at zero indicates no effect. The plot weights studies based on precision, with Kobyliak (2018) having the highest weight of 69.38%. Heterogeneity is indicated by I-squared at 4.1% and p-value at 0.406.</alt-text>
</graphic>
</fig>
<fig position="float" id="fig4">
<label>Figure 4</label>
<caption>
<p>Forest plot for waist circumference.</p>
</caption>
<graphic xlink:href="fmicb-16-1633434-g004.tif" mimetype="image" mime-subtype="tiff">
<alt-text content-type="machine-generated">Forest plot from a meta-analysis shows weighted mean differences (WMD) with confidence intervals for various studies. Each study, labeled by year and author, is represented by a dot with a horizontal line. The overall effect size is depicted at the bottom with a diamond shape, indicating a WMD of -0.35 with this analysis reported to have high heterogeneity (I-squared = 88.3%).</alt-text>
</graphic>
</fig>
</sec>
</sec>
<sec id="sec20">
<label>3.4</label>
<title>Secondary outcomes</title>
<sec id="sec21">
<label>3.4.1</label>
<title>Effects of <italic>Bifidobacterium</italic> on glycemic control</title>
<p>Ten studies evaluated how <italic>Bifidobacterium</italic> supplementation influences FBG within the cohort with excess weight or obesity. <italic>Bifidobacterium</italic> did not markedly affect FBG (SMD: -0.143; 95% CI: &#x2212;0.302, &#x2212;0.016, <italic>I<sup>2</sup></italic> =&#x202F;0.0%) (<xref ref-type="fig" rid="fig5">Figure 5</xref>). Our sensitivity analysis indicated robustness. Egger&#x2019;s test (<italic>p</italic>&#x202F;=&#x202F;0.215) and the funnel plot demonstrated no publication bias, as depicted in <xref rid="SM1" ref-type="supplementary-material">Supplementary Figures 6, 7</xref>.</p>
<fig position="float" id="fig5">
<label>Figure 5</label>
<caption>
<p>Forest plot for fasting blood glucose.</p>
</caption>
<graphic xlink:href="fmicb-16-1633434-g005.tif" mimetype="image" mime-subtype="tiff">
<alt-text content-type="machine-generated">Forest plot showing effect sizes from nine studies with 95% confidence intervals (CI) and percentage weights. Individual study results vary from negative to positive, with an overall standardized mean difference (SMD) of -0.14 (95% CI: -0.30, 0.02). The summary estimate is represented by a diamond. Heterogeneity is low with I-squared at 0.0% and a p-value of 0.533.</alt-text>
</graphic>
</fig>
<p>Seven studies investigated the effect of <italic>Bifidobacterium</italic> on HbA1c, demonstrating insignificant variations across groups (WMD: &#x2212;0.093%; 95% CI: &#x2212;0.277, &#x2212;0.091, <italic>I<sup>2</sup></italic> =&#x202F;56.4%) (<xref ref-type="fig" rid="fig6">Figure 6</xref>). However, regarding insulin levels, seven studies reported a notable decrease in insulin levels in the <italic>Bifidobacterium</italic> supplementation cohort (SMD: &#x2212;0.268; 95% CI: &#x2212;0.470, &#x2212;0.066, <italic>I<sup>2</sup></italic> =&#x202F;5.4%) (<xref ref-type="fig" rid="fig7">Figure 7</xref>). These findings were robust after sensitivity analysis, as presented in <xref rid="SM1" ref-type="supplementary-material">Supplementary Figures 8, 9</xref>.</p>
<fig position="float" id="fig6">
<label>Figure 6</label>
<caption>
<p>Forest plot for glycated hemoglobin.</p>
</caption>
<graphic xlink:href="fmicb-16-1633434-g006.tif" mimetype="image" mime-subtype="tiff">
<alt-text content-type="machine-generated">Forest plot showing weighted mean differences (WMD) with 95% confidence intervals for various studies on a vertical axis. Individual study points are marked with black diamonds and horizontal lines, indicating each study's results and variability. The overall effect is represented by a diamond, with a central vertical line marking zero effect. Study weights are indicated on the right, and the note mentions that weights are from random effects analysis.</alt-text>
</graphic>
</fig>
<fig position="float" id="fig7">
<label>Figure 7</label>
<caption>
<p>Forest plot for insulin.</p>
</caption>
<graphic xlink:href="fmicb-16-1633434-g007.tif" mimetype="image" mime-subtype="tiff">
<alt-text content-type="machine-generated">Forest plot showing standardized mean differences (SMD) and 95% confidence intervals for seven studies. Individual study results are plotted with horizontal lines and diamonds, with a vertical dashed line indicating no effect. Overall results are summarized at the bottom, showing a pooled SMD of -0.27 with a 95% confidence interval of -0.47 to -0.07. The heterogeneity is low (I-squared = 5.4%, p = 0.398).</alt-text>
</graphic>
</fig>
</sec>
<sec id="sec22">
<label>3.4.2</label>
<title>Effects of <italic>Bifidobacterium</italic> on lipid metabolism</title>
<p>To unravel how <italic>Bifidobacterium</italic> impacts lipid metabolism, our study incorporated studies evaluating TC, TG, HDL-C, and LDL-C. The effects on lipid levels were insignificant.</p>
<p>Specifically, eleven studies regarding TC, TG, and HDL-C suggested insignificant effects of <italic>Bifidobacterium</italic> supplementation (TC: SMD: -0.082; 95% CI: &#x2212;0.235, 0.071, <italic>I<sup>2</sup></italic> =&#x202F;41.4%; TG: SMD: -0.423; 95% CI: &#x2212;0.939, 0.094, <italic>I<sup>2</sup></italic> =&#x202F;90.2%; HDL-C: SMD: 0.060; 95% CI: &#x2212;0.209, 0.328, <italic>I<sup>2</sup></italic> =&#x202F;65.6%) (<xref ref-type="fig" rid="fig8">Figures 8</xref>&#x2013;<xref ref-type="fig" rid="fig10">10</xref>). The robustness of the foregoing results was proved by utilizing sensitivity analysis. Publication bias did not exist in funnel plots and Egger&#x2019;s test (<xref rid="SM1" ref-type="supplementary-material">Supplementary Figures 10&#x2013;15</xref>).</p>
<fig position="float" id="fig8">
<label>Figure 8</label>
<caption>
<p>Forest plot for total cholesterol.</p>
</caption>
<graphic xlink:href="fmicb-16-1633434-g008.tif" mimetype="image" mime-subtype="tiff">
<alt-text content-type="machine-generated">Forest plot displaying standardized mean differences (SMD) with 95% confidence intervals for multiple studies: AlMalki, Bai, Hadi, Hibberd, Kanazawa, Lauw, Majewska, Parascinet, Sudha, Ebrahimi, Wu, and overall result. The overall SMD is -0.08, 95% CI (-0.24, 0.07) with I-squared at 41.4% and p-value of 0.073. Each horizontal line represents a study's effect estimate and confidence interval. The diamond at the bottom represents the overall effect estimate.</alt-text>
</graphic>
</fig>
<fig position="float" id="fig9">
<label>Figure 9</label>
<caption>
<p>Forest plot for triglycerides.</p>
</caption>
<graphic xlink:href="fmicb-16-1633434-g009.tif" mimetype="image" mime-subtype="tiff">
<alt-text content-type="machine-generated">Forest plot showing results of multiple studies. Each study, identified by author and year, has a square and horizontal line representing the standardized mean difference (SMD) and 95% confidence interval. Weights of studies vary, with an overall SMD of -0.42. The overall effect is marked by a diamond shape, with high heterogeneity noted (I-squared = 90.2%, p = 0.000).</alt-text>
</graphic>
</fig>
<fig position="float" id="fig10">
<label>Figure 10</label>
<caption>
<p>Forest plot for high-density lipoprotein.</p>
</caption>
<graphic xlink:href="fmicb-16-1633434-g010.tif" mimetype="image" mime-subtype="tiff">
<alt-text content-type="machine-generated">Forest plot displaying standardized mean differences (SMD) with 95% confidence intervals for various studies. The plot includes individual study estimates and weights such as AlMalki (2024) SMD -0.11, Wu (2024) SMD 0.42. The overall effect is shown with an SMD of 0.06. A dashed line at zero indicates no effect. Weights calculated using a random effects model, with heterogeneity I-squared 65.6% and p-value 0.001.</alt-text>
</graphic>
</fig>
<p>Eight studies examined the impact of <italic>Bifidobacterium</italic> on LDL-C and revealed no evident effect (SMD: -0.108; 95% CI: &#x2212;0.379, 0.162, <italic>I<sup>2</sup></italic> =&#x202F;52.6%) (<xref ref-type="fig" rid="fig11">Figure 11</xref>). Sequential exclusion of individual studies in sensitivity analyses did not markedly affect the results, as presented in <xref rid="SM1" ref-type="supplementary-material">Supplementary Figure 16</xref>.</p>
<fig position="float" id="fig11">
<label>Figure 11</label>
<caption>
<p>Forest plot for low-density lipoprotein.</p>
</caption>
<graphic xlink:href="fmicb-16-1633434-g011.tif" mimetype="image" mime-subtype="tiff">
<alt-text content-type="machine-generated">Forest plot displaying standardized mean differences (SMD) with 95% confidence intervals for eight studies from 2016 to 2024. Individual study weights and overall effect size are indicated. Weights are derived from random effects analysis. Overall effect (I-squared = 52.0%, p = 0.039).</alt-text>
</graphic>
</fig>
</sec>
</sec>
</sec>
<sec sec-type="discussion" id="sec23">
<label>4</label>
<title>Discussion</title>
<p>This meta-analysis assessed the impact of <italic>Bifidobacterium</italic> supplementation on individuals with overweight or obesity. Our study on 21 RCTs proved that <italic>Bifidobacterium</italic> supplementation is effective in managing weight of the overweight or obese patients. The <italic>Bifidobacterium</italic> cohort had a prominent decline in weight and BMI, though no significant effect on WC was observed. Furthermore, supplementation with <italic>Bifidobacterium</italic> did not notably lower FBG or HbA1c but was linked to improved insulin levels. In contrast, marked differences were not found across the two groups with regard to TC, TG, HDL-C, and LDL-C. Therefore, <italic>Bifidobacterium</italic> supplementation is beneficial for overweight or obese individuals, potentially aiding in weight control and improving insulin secretion.</p>
<p>Probiotics, including <italic>Bifidobacterium</italic>, have been shown to help manage overweight and obesity (<xref ref-type="bibr" rid="ref14">Geng et al., 2022</xref>). Our findings prove that <italic>Bifidobacterium</italic> supplementation lowers the weight and BMI of the population with excess weight or obesity, which aligns with previous research results (<xref ref-type="bibr" rid="ref35">Sadeghi et al., 2024</xref>). <italic>Bifidobacterium</italic> may promote the production of SCFAs, such as acetate, propionate, and butyrate, in the gut. These SCFAs can activate the AMPK pathway in the liver, muscle, and adipose tissues. AMPK phosphorylates acetyl-CoA carboxylase (ACC), thereby inhibiting fatty acid synthesis, while simultaneously activating carnitine palmitoyltransferase-1 (CPT-1), which facilitates the mitochondrial uptake and oxidation of fatty acids, enhancing lipid catabolism (<xref ref-type="bibr" rid="ref46">Yun et al., 2024</xref>). In overweight or obese individuals, sustained supplementation with <italic>Bifidobacterium</italic> may reduce excessive lipid absorption. Furthermore, SCFAs can activate free fatty acid receptors (FFAR2/3) on intestinal epithelial cells, stimulating the secretion of glucagon-like peptide-1 (GLP-1) and peptide YY (PYY), which suppress the release of the appetite-stimulating hormone ghrelin (<xref ref-type="bibr" rid="ref20">Horiuchi et al., 2020</xref>). This leads to reduced food intake and subsequent caloric restriction, thereby contributing to a natural decline in BMI. Individuals with obesity often exhibit lower levels of SCFAs produced by gut microbiota; supplementation with probiotics such as <italic>Bifidobacterium</italic> can enhance SCFA production, increase satiety, and promote weight reduction. <xref ref-type="bibr" rid="ref27">L&#x00F3;pez-Moreno et al. (2020)</xref> noted marked weight and BMI drops in a cohort receiving probiotics containing <italic>Bifidobacterium</italic> in contrast to a placebo cohort. Nevertheless, this meta-analysis found no significant reduction in WC among overweight or obese individuals receiving <italic>Bifidobacterium</italic> supplementation. <xref ref-type="bibr" rid="ref12">Ejtahed et al. (2019)</xref> demonstrated that probiotic intervention over 2&#x2013;24&#x202F;weeks was effective in reducing WC in overweight or obese subjects, which may be attributed to the relatively shorter intervention period (less than 12&#x202F;weeks) in the present study. Additionally, there exist gender differences in probiotic effects on weight management among the overweight or obese population, with some studies noting a reduction in WC only in women (<xref ref-type="bibr" rid="ref8">Cao et al., 2024</xref>). This may also explain the insignificant effect on WC in our findings.</p>
<p>Our study demonstrated that supplementation with <italic>Bifidobacterium</italic> significantly reduced insulin levels in overweight or obese individuals. This effect may be attributed to the capacity of <italic>Bifidobacterium</italic> to reshape the composition and function of the gut microbiota. In such populations, its metabolic byproducts, particularly SCFAs, may activate the gut-metabolism axis, enhance insulin signaling, reduce adipose tissue accumulation, improve insulin sensitivity, and ultimately lower the risk of obesity-related diseases (<xref ref-type="bibr" rid="ref16">Guney-Coskun and Basaranoglu, 2024</xref>). <xref ref-type="bibr" rid="ref42">Teo et al. (2024)</xref> also proved that probiotics containing <italic>Bifidobacterium</italic> were more effective in improving insulin levels. Although the present study supports the beneficial role of <italic>Bifidobacterium</italic> in modulating insulin levels, the differences in the results are relatively small. Further randomized controlled trials and prospective cohort studies are warranted to elucidate the role of Bifidobacterium in mitigating insulin resistance among obese populations. Furthermore, this meta-analysis found no significant changes in FBG or HbA1c levels. <xref ref-type="bibr" rid="ref6">Barengolts et al. (2019)</xref> also reported no changes in HbA1c, FBG, or fasting insulin following consumption of <italic>Bifidobacterium</italic>-containing probiotic yogurt in the obese cohort with T2DM in comparison to traditional yogurt. This may be because <italic>Bifidobacterium</italic>&#x2019;s effect on postprandial blood glucose is more prominent. Therefore, additional research is necessitated to verify the efficacy of <italic>Bifidobacterium</italic> supplementation in managing blood glucose levels in overweight or obese individuals.</p>
<p>This study found no significant effect of <italic>Bifidobacterium</italic> on lipid metabolism in the experimental group, suggesting that <italic>Bifidobacterium</italic> may primarily exert its effects through energy metabolism rather than lipid redistribution. Dong et al.&#x2019;s meta-analysis (<xref ref-type="bibr" rid="ref11">Dong et al., 2019</xref>) also reported insignificant disparities in TC, TG, or HDL between the intervention group (which used probiotic foods and <italic>Bifidobacterium</italic>-containing supplements) and the control group in individuals with metabolic syndrome. Additionally, other studies (<xref ref-type="bibr" rid="ref34">Ruscica et al., 2019</xref>) have indicated that <italic>Bifidobacterium longum</italic> evidently reduces serum TC and LDL-C in the hyperlipidemic population by influencing gut microbiota composition and fecal metabolic products. This discrepancy possibly arises from differences in the specific strains of <italic>Bifidobacterium</italic> in this study, as the lipid-lowering effects of different <italic>Bifidobacterium</italic> strains may vary. Although our study showed no significant effect on these lipid parameters, interest in the role of <italic>Bifidobacterium</italic> in lipid metabolism remains strong in the academic community. High-quality RCTs are necessitated to better elucidate the efficacy of <italic>Bifidobacterium</italic> in lipid metabolism.</p>
<p>This study has two limitations. First, heterogeneity in the studies on <italic>Bifidobacterium</italic> may confound the results due to differences in ethnicity, sex, strain types, and dosages. Second, the lack of standardization in the units of measurement for blood glucose and lipids may introduce measurement errors. However, efforts were made in this study to minimize such effects through standardization.</p>
</sec>
<sec sec-type="conclusions" id="sec24">
<label>5</label>
<title>Conclusion</title>
<p>In conclusion, this study suggests that supplementation with <italic>Bifidobacterium</italic> exerts a moderate positive effect on lowering the weight and BMI of overweight or obese people, indicating that <italic>Bifidobacterium</italic> may serve as an adjunct in weight management for these individuals. Additionally, our findings demonstrate a beneficial role of <italic>Bifidobacterium</italic> in regulating insulin levels in overweight or obese patients, though its effects on improving hyperglycemia and hyperlipidemia were limited. Future studies should focus on high-quality clinical trials that consider individual factors such as gender, fat distribution, and strain specificity. Specific <italic>Bifidobacterium</italic> strains may have superior effects, and more research is necessitated to verify the role of <italic>Bifidobacterium</italic> in managing weight, providing valuable insights into its potential applications.</p>
</sec>
</body>
<back>
<sec sec-type="data-availability" id="sec25">
<title>Data availability statement</title>
<p>The original contributions presented in the study are included in the article/<xref rid="SM1" ref-type="supplementary-material">Supplementary material</xref>, further inquiries can be directed to the corresponding author.</p>
</sec>
<sec sec-type="author-contributions" id="sec26">
<title>Author contributions</title>
<p>JH: Conceptualization, Methodology, Software, Writing &#x2013; original draft, Writing &#x2013; review &#x0026; editing. HC: Data curation, Software, Writing &#x2013; review &#x0026; editing.</p>
</sec>
<sec sec-type="funding-information" id="sec27">
<title>Funding</title>
<p>The author(s) declare that no financial support was received for the research and/or publication of this article.</p>
</sec>
<sec sec-type="COI-statement" id="sec28">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec sec-type="ai-statement" id="sec29">
<title>Generative AI statement</title>
<p>The author(s) declare that no Gen AI was used in the creation of this manuscript.</p>
<p>Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.</p>
</sec>
<sec sec-type="disclaimer" id="sec30">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<sec sec-type="supplementary-material" id="sec31">
<title>Supplementary material</title>
<p>The Supplementary material for this article can be found online at: <ext-link xlink:href="https://www.frontiersin.org/articles/10.3389/fmicb.2025.1633434/full#supplementary-material" ext-link-type="uri">https://www.frontiersin.org/articles/10.3389/fmicb.2025.1633434/full#supplementary-material</ext-link></p>
<supplementary-material xlink:href="Supplementary_file_1.docx" id="SM1" mimetype="application/vnd.openxmlformats-officedocument.wordprocessingml.document" xmlns:xlink="http://www.w3.org/1999/xlink"/>
</sec>
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