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The Effects of Synbiotic Supplementation on Metabolic Status in Diabetic Patients Undergoing Hemodialysis: a Randomized, Double-Blinded, Placebo-Controlled Trial

  • Alireza Soleimani
  • Alireza Motamedzadeh
  • Malihe Zarrati Mojarrad
  • Fereshteh Bahmani
  • Elaheh Amirani
  • Vahidreza Ostadmohammadi
  • Maryam Tajabadi-Ebrahimi
  • Zatollah AsemiEmail author
Article

Abstract

This study was conducted to evaluate the effects of synbiotic supplementation on metabolic profiles in diabetic patients undergoing hemodialysis (HD). This randomized, double-blinded, placebo-controlled clinical trial was performed in 60 diabetic HD patients. Participants were randomly assigned into two groups to receive either synbiotic capsule, containing Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium bifidum (2 × 109 CFU/g each), plus 0.8 g/day of inulin (n = 30) or placebo (n = 30) for 12 weeks. Synbiotic supplementation significantly decreased fasting plasma glucose (β − 13.56 mg/dL; 95% CI, − 23.82, − 3.30; P = 0.01), insulin levels (β − 5.49 μIU/mL; 95% CI, − 6.92, − 4.05; P < 0.001), and insulin resistance (β − 2.25; 95% CI, − 3.02, − 1.48; P < 0.001), while increased the quantitative insulin sensitivity check index (β 0.02; 95% CI, 0.01, 0.02; P < 0.001) compared with the placebo. Additionally, synbiotic intake resulted in a significant reduction in high-sensitivity C-reactive protein (β − 2930.48 ng/mL; 95% CI, − 3741.15, − 2119.80; P < 0.001) and malondialdehyde levels (β − 0.60 μmol/L; 95% CI, − 0.99, − 0.20; P = 0.003). Moreover, we found a significant increase in total antioxidant capacity (β 142.99 mmol/L; 95% CI, 61.72, 224.25; P = 0.001) and total glutathione levels (β 131.11 μmol/L; 95% CI, 89.35, 172.87; P < 0.001) in the synbiotic group compared with the placebo group. Overall, synbiotic supplementation for 12 weeks had beneficial effects on glycemic control, biomarkers of inflammation, and oxidative stress in diabetic patients under HD. This study was registered in the Iranian website (www.irct.ir) for registration of clinical trials (http://www.irct.ir: IRCT2017090133941N17). http://www.irct.ir: IRCT2017090133941N17.

Keywords

Synbiotic supplementation Diabetes Hemodialysis Metabolic status 

Abbreviations

ESRD

end-stage renal disease

FPG

fasting plasma glucose

GLP1

glucagon-like peptide-1

GSH

total glutathione

HD

hemodialysis

HOMA-IR

homeostasis model of assessment-insulin resistance

HDL-cholesterol

high-density lipoprotein-cholesterol

hs-CRP

high-sensitivity C-reactive protein

LDL-cholesterol

low-density lipoprotein-cholesterol

MDA

malondialdehyde

NO

nitric oxide

QUICKI

quantitative insulin sensitivity check index

SCFA

short-chain fatty acids

SGA

subjective global assessment

T2DM

type 2 diabetes mellitus

TAC

total antioxidant capacity

VLDL-cholesterol

very-low-density lipoprotein-cholesterol

Notes

Acknowledgements

The present study was supported by a grant from the Vice-chancellor for Research, KAUMS, and Iran. The authors would like to thank the staff of Akhavan Clinic (Kashan, Iran) for their assistance in this project. The authors of this study would like to appreciate Dr. Naghmeh Mirhosseini for a scientific review and edition of the paper.

Author Contributions

ZA: Conception, design, and statistical analysis, drafting of the manuscript, and supervised the study.

AS, AM, MZ-M, FB, EA, VO, and MT-E: data collection and manuscript drafting.

Funding

The research grant provided by Research Deputy of Kashan University of Medical Sciences (KAUMS).

Compliance with Ethical Standards

Ethics Approval and Consent to Participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments.

Consent for Publication

Not applicable.

Availability of Data and Material

The primary data for this study is available from the authors on direct request.

Competing Interests

The authors declare that they have no conflict of interest.

Supplementary material

12602_2018_9499_MOESM1_ESM.docx (13 kb)
Supplementary file 1 (DOCX 13 kb)

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Copyright information

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

Authors and Affiliations

  • Alireza Soleimani
    • 1
  • Alireza Motamedzadeh
    • 1
  • Malihe Zarrati Mojarrad
    • 2
  • Fereshteh Bahmani
    • 2
  • Elaheh Amirani
    • 2
  • Vahidreza Ostadmohammadi
    • 2
  • Maryam Tajabadi-Ebrahimi
    • 3
  • Zatollah Asemi
    • 2
    Email author
  1. 1.Department of Internal MedicineKashan University of Medical SciencesKashanIran
  2. 2.Research Center for Biochemistry and Nutrition in Metabolic DiseasesKashan University of Medical SciencesKashanIran
  3. 3.Faculty member of Science department, science facultyIslamic Azad University Tehran Central BranchTehranIran

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