Obesity Surgery

, Volume 28, Issue 9, pp 2874–2885 | Cite as

Probiotic Supplementation in Morbid Obese Patients Undergoing One Anastomosis Gastric Bypass-Mini Gastric Bypass (OAGB-MGB) Surgery: a Randomized, Double-Blind, Placebo-Controlled, Clinical Trial

  • Zohreh Karbaschian
  • Zeinab Mokhtari
  • Abdolreza Pazouki
  • Ali Kabir
  • Mahdi Hedayati
  • Somayeh Soleymanzadeh Moghadam
  • Parvin MirmiranEmail author
  • Azita HekmatdoostEmail author
Original Contributions



Bariatric surgery is known as one of the most effective treatments for sustainable weight loss; however, it may be associated with some complications. This study was designed to examine the effects of probiotic supplementation on some morbidities related to this surgery.


This was a placebo-controlled, double-blind, randomized clinical trial on morbid obese patients referred for One Anastomosis Gastric Bypass- Mini Gastric Bypass (OAGB-MGB) surgery to a tertiary referral center. Patients were assigned to receive a probiotic supplement (Familact®) or placebo from 4 weeks prior to surgery to 12 weeks after surgery. Anthropometric, biochemical, and inflammatory indices were evaluated at the beginning and the end of the study.


At the end of study, significant improvements in some serum inflammatory markers, vitamin D status, and anthropometric measurements were observed (p < 0.05), which were significantly more in probiotic group rather than placebo group (p < 0.05). Moreover, significant improvements in glycemic indices and lipid profile were observed in both groups; however, these changes were not significantly different between the groups. There was no significant difference in serum levels of vitamin B12, folate, and homocysteine between groups at week 16 of the study.


Our results indicate that probiotic supplementation promotes inflammatory markers, body weight loss, and status of vitamin D in patients undergoing OAGB-MGB bypass. Whether these findings will sustain in longer treatment duration remained to be elucidated in future studies.

Trial Registration

This study has been registered at with registration number NCT02708589.


Probiotics Gastric surgery Obesity OAGB-MGB One anastomosis gastric bypass- mini gastric bypass surgery Morbidity Clinical trial 



We appreciate all participants and the staffs of Rasoul Hospital, without whom this study was impossible.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest. The study was financially supported by Endocrine Research Institute of SBMU with grant number 1394215/787.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Ethical Approval

All procedures performed in this study were approved by the institutional research committee and in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


  1. 1.
    Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378(9793):804–14.CrossRefPubMedGoogle Scholar
  2. 2.
    Gregor MF, Hotamisligil GS. Inflammatory mechanisms in obesity. Annu Rev Immunol. 2011;29:415–45.CrossRefPubMedGoogle Scholar
  3. 3.
    Mahawar KK, Kumar P, Carr WRJ, et al. Current status of mini-gastric bypass. Journal of Minimal Access Surgery. 2016;12(4):305–10.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Almalki OM, Lee W-J, Chen J-C, et al. Revisional gastric bypass for failed restrictive procedures: comparison of single-anastomosis (mini-) and Roux-en-Y gastric bypass. Obes Surg. 2017;27(11):2861–2867Google Scholar
  5. 5.
    Maciejewski ML, Arterburn DE, Van Scoyoc L, et al. Bariatric surgery and long-term durability of weight loss. JAMA surgery. 2016;151(11):1046–55.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Mahawar KK, Jennings N, Brown J, et al. "Mini" gastric bypass: systematic review of a controversial procedure. Obes Surg. 2013;23(11):1890–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Tack J, Deloose E. Complications of bariatric surgery: dumping syndrome, reflux and vitamin deficiencies. Best Pract Res Clin Gastroenterol. 2014;28(4):741–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Faintuch J, Ishida RK, Jacabi M, et al. Increased gastric cytokine production after Roux-en-Y gastric bypass for morbid obesity. Arch Surg. 2007;142(10):962–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Van Dielen F, Buurman W, Hadfoune M, et al. Macrophage inhibitory factor, plasminogen activator inhibitor-1, other acute phase proteins, and inflammatory mediators normalize as a result of weight loss in morbidly obese subjects treated with gastric restrictive surgery. J Clin Endocrinol Metab. 2004;89(8):4062–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Dalmas E, Rouault C, Abdennour M, et al. Variations in circulating inflammatory factors are related to changes in calorie and carbohydrate intakes early in the course of surgery-induced weight reduction. Am J Clin Nutr. 2011;94(2):450–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Pitsouni E, Alexiou V, Saridakis V, et al. Does the use of probiotics/synbiotics prevent postoperative infections in patients undergoing abdominal surgery? A meta-analysis of randomized controlled trials. Eur J Clin Pharmacol. 2009;65(6):561–70.CrossRefPubMedGoogle Scholar
  12. 12.
    Cox AJ, West NP, Cripps AW. Obesity, inflammation, and the gut microbiota. The lancet Diabetes & endocrinology. 2015;3(3):207–15.CrossRefGoogle Scholar
  13. 13.
    Eslamparast T, Eghtesad S, Hekmatdoost A, et al. Probiotics and nonalcoholic fatty liver disease. Middle East J Dig Dis. 2013;5(3):129–36.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Eslamparast T, Poustchi H, Zamani F, et al. Synbiotic supplementation in nonalcoholic fatty liver disease: a randomized, double-blind, placebo-controlled pilot study. Am J Clin Nutr. 2014;99(3):535–42.CrossRefPubMedGoogle Scholar
  15. 15.
    Eslamparast T, Zamani F, Hekmatdoost A, et al. Effects of synbiotic supplementation on insulin resistance in subjects with the metabolic syndrome: a randomised, double-blind, placebo-controlled pilot study. Br J Nutr. 2014;112(3):438–45.CrossRefPubMedGoogle Scholar
  16. 16.
    Hekmatdoost A, Feizabadi MM, Djazayery A, et al. The effect of dietary oils on cecal microflora in experimental colitis in mice. Indian J Gastroenterol. 2008;27(5):186–9.PubMedGoogle Scholar
  17. 17.
    Mofidi F, Poustchi H, Yari Z, et al. Synbiotic supplementation in lean patients with non-alcoholic fatty liver disease: a pilot, randomised, double-blind, placebo-controlled, clinical trial. Br J Nutr. 2017;117(5):662–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Mofidi F, Yari Z, Poustchi H, et al. Effects of synbiotics supplementation in lean patients with nonalcoholic fatty liver disease: study protocol of a pilot randomized double-blind clinical trial. Arch Iran Med. 2016;19(4):282–4.PubMedGoogle Scholar
  19. 19.
    Mokhtari Z, Gibson DL, Hekmatdoost A. Nonalcoholic fatty liver disease, the gut microbiome, and diet. Adv Nutr. 2017;8(2):240–52.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Shavakhi A, Minakari M, Firouzian H, et al. Effect of a probiotic and metformin on liver aminotransferases in non-alcoholic steatohepatitis: a double blind randomized clinical trial. Int J Prev Med. 2013;4(5):531–7.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Ley RE, Turnbaugh PJ, Klein S, et al. Microbial ecology: human gut microbes associated with obesity. Nature. 2006;444(7122):1022–3.CrossRefPubMedGoogle Scholar
  22. 22.
    Woodard GA, Encarnacion B, Downey JR, et al. Probiotics improve outcomes after Roux-en-Y gastric bypass surgery: a prospective randomized trial. J Gastrointest Surg. 2009;13(7):1198–204.CrossRefPubMedGoogle Scholar
  23. 23.
    Sabate JM, Coupaye M, Ledoux S, et al. Consequences of small intestinal bacterial overgrowth in obese patients before and after bariatric surgery. Obes Surg. 2017;27(3):599–605.CrossRefPubMedGoogle Scholar
  24. 24.
    Stoll LL, Denning GM, Weintraub NL. Potential role of endotoxin as a proinflammatory mediator of atherosclerosis. Arterioscler Thromb Vasc Biol. 2004;24(12):2227–36.CrossRefPubMedGoogle Scholar
  25. 25.
    Hegazy SK, El-Bedewy MM. Effect of probiotics on pro-inflammatory cytokines and NF-κB activation in ulcerative colitis. World J Gastroenterol: WJG. 2010;16(33):4145–51.CrossRefPubMedGoogle Scholar
  26. 26.
    Ashraf R, Shah NP. Immune system stimulation by probiotic microorganisms. Crit Rev Food Sci Nutr. 2014;54(7):938–56.CrossRefPubMedGoogle Scholar
  27. 27.
    Dror T, Dickstein Y, Dubourg G, et al. Microbiota manipulation for weight change. Microb Pathog. 2017;106:146–61.CrossRefPubMedGoogle Scholar
  28. 28.
    LeBlanc J, Laiño J, del Valle MJ, et al. B-group vitamin production by lactic acid bacteria—current knowledge and potential applications. J Appl Microbiol. 2011;111(6):1297–309.CrossRefPubMedGoogle Scholar
  29. 29.
    Jones ML, Martoni CJ, Prakash S. Oral supplementation with probiotic L. reuteri NCIMB 30242 increases mean circulating 25-hydroxyvitamin D: a post hoc analysis of a randomized controlled trial. The Journal of Clinical Endocrinology & Metabolism. 2013;98(7):2944–51.CrossRefGoogle Scholar
  30. 30.
    Vargas-Ruiz AG, Hernández-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18(3):288–93.CrossRefPubMedGoogle Scholar
  31. 31.
    Sherf-Dagan S, Zelber-Sagi S, Zilberman-Schapira G, et al. Probiotics administration following sleeve gastrectomy surgery: a randomized double-blind trial. Int J Obes. 2017;1:9.Google Scholar
  32. 32.
    Chen J-C, Lee W-J, Tsou J-J, et al. Effect of probiotics on postoperative quality of gastric bypass surgeries: a prospective randomized trial. Surg Obes Relat Dis. 2016;12(1):57–61.CrossRefPubMedGoogle Scholar
  33. 33.
    Initiative, N.O.E., N. Heart, Lung et al. The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. Lung, and Blood Institute: National Heart; 2002.Google Scholar
  34. 34.
    Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21(0 1):S1–27Google Scholar
  35. 35.
    Deitel M, Gawdat K, Melissas J. Reporting weight loss 2007. Obes Surg. 2007;17(5):565–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Organization, W.H. STEPwise approach to surveillance (STEPS) Geneva, Switzerland: WHO; 2016. 2016.Google Scholar
  37. 37.
    Matthews D, Hosker J, Rudenski A, et al. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Katz A, Nambi SS, Mather K, et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. The Journal of Clinical Endocrinology & Metabolism. 2000;85(7):2402–10.CrossRefGoogle Scholar
  39. 39.
    Gareau MG, Sherman PM, Walker WA. Probiotics and the gut microbiota in intestinal health and disease. Nature Reviews Gastroenterology and Hepatology. 2010;7(9):503–14.CrossRefPubMedGoogle Scholar
  40. 40.
    Fernandes R, Beserra BT, Mocellin MC, et al. Effects of prebiotic and synbiotic supplementation on inflammatory markers and anthropometric indices after Roux-en-Y gastric bypass: a randomized, triple-blind, placebo-controlled pilot study. J Clin Gastroenterol. 2016;50(3):208–17.CrossRefPubMedGoogle Scholar
  41. 41.
    Groeger D, O’Mahony L, Murphy EF, et al. Bifidobacterium infantis 35624 modulates host inflammatory processes beyond the gut. Gut Microbes. 2013;4(4):325–39.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Reddy B, Macfie J, Gatt M, et al. Randomized clinical trial of effect of synbiotics, neomycin and mechanical bowel preparation on intestinal barrier function in patients undergoing colectomy. Br J Surg. 2007;94(5):546–54.CrossRefPubMedGoogle Scholar
  43. 43.
    Kekkonen, R.A., N. Lummela, H. Karjalainen, , S. Latvala, S. Tynkkynen, S. Järvenpää, H. Kautiainen, I. Julkunen, H. Vapaatalo, R. Korpela et al., Probiotic intervention has strain-specific anti-inflammatory effects in healthy adults. World J Gastroenterol: WJG, 2008. 14(13): p. 2029, 2036.CrossRefPubMedGoogle Scholar
  44. 44.
    Thomas CM, Versalovic J. Probiotics-host communication: modulation of signaling pathways in the intestine. Gut Microbes. 2010;1(3):148–63.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Park S, Bae J-H. Probiotics for weight loss: a systematic review and meta-analysis. Nutr Res. 2015;35(7):566–75.CrossRefPubMedGoogle Scholar
  46. 46.
    Arora T, Singh S, Sharma RK. Probiotics: interaction with gut microbiome and antiobesity potential. Nutrition. 2013;29(4):591–6.CrossRefPubMedGoogle Scholar
  47. 47.
    Sun J, Buys NJ. Glucose- and glycaemic factor-lowering effects of probiotics on diabetes: a meta-analysis of randomised placebo-controlled trials. Br J Nutr. 2016;115(7):1167–77.CrossRefPubMedGoogle Scholar
  48. 48.
    Guo Z, Liu X, Zhang Q, et al. Influence of consumption of probiotics on the plasma lipid profile: a meta-analysis of randomised controlled trials. Nutr Metab Cardiovasc Dis. 2011;21(11):844–50.CrossRefPubMedGoogle Scholar
  49. 49.
    LeBlanc JG, Chain F, Martín R, et al. Beneficial effects on host energy metabolism of short-chain fatty acids and vitamins produced by commensal and probiotic bacteria. Microb Cell Factories. 2017;16(1):79.CrossRefGoogle Scholar
  50. 50.
    Rossi M, Amaretti A, Raimondi S. Folate production by probiotic bacteria. Nutrients. 2011;3(1):118–34.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Blom HJ, Smulders Y. Overview of homocysteine and folate metabolism. With special references to cardiovascular disease and neural tube defects. J Inherit Metab Dis. 2011;34(1):75–81.CrossRefPubMedGoogle Scholar
  52. 52.
    Vollset SE, Refsum H, Irgens LM, et al. Plasma total homocysteine, pregnancy complications, and adverse pregnancy outcomes: the Hordaland Homocysteine study. Am J Clin Nutr. 2000;71(4):962–8.CrossRefPubMedGoogle Scholar
  53. 53.
    Signori C, Zalesin KC, Franklin B, et al. Effect of gastric bypass on vitamin D and secondary hyperparathyroidism. Obes Surg. 2010;20(7):949–52.CrossRefPubMedGoogle Scholar
  54. 54.
    Coupaye M, Breuil MC, Rivière P, et al. Serum vitamin D increases with weight loss in obese subjects 6 months after Roux-en-Y gastric bypass. Obes Surg. 2013;23(4):486–93.CrossRefPubMedGoogle Scholar
  55. 55.
    Chakhtoura MT, Nakhoul NN, Shawwa K, et al. Hypovitaminosis D in bariatric surgery: a systematic review of observational studies. Metabolism. 2016;65(4):574–85.CrossRefPubMedGoogle Scholar
  56. 56.
    Shang M, Sun J. Vitamin D/VDR, probiotics, and gastrointestinal diseases. Curr Med Chem. 2017;24(9):876–87.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.International Branch, Shahid Beheshti University of Medical SciencesTehranIran
  2. 2.Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research InstituteShahid Beheshti University of Medical SciencesTehranIran
  3. 3.Minimally Invasive Surgery Division, Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran, Head, Center of Excellence for Minimally Invasive Surgery TrainingIran University of Medical SciencesTehranIran
  4. 4.Center of Excellence of European Branch of International Federation for Surgery of ObesityTehranIran
  5. 5.Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
  6. 6.Antimicrobial Resistance Research Center, Institute of Immunology and Infectious DiseaseIran University of Medical SciencesTehranIran
  7. 7.Nutrition and Endocrine Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran

Personalised recommendations