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The effect of probiotics, prebiotics, and synbiotics on hormonal and inflammatory indices in women with polycystic ovary syndrome: a systematic review and meta-analysis

European Journal of Nutrition volume 59, pages 433–450 (2020)Cite this article

Abstract

Introduction

Polycystic ovary syndrome (PCOS) is among the most prevalent endocrine disorders in women and can lead to many other disorders and chronic diseases. Thus, early diagnosis and treatment of this syndrome is important. Using probiotics, prebiotics, and synbiotics supplementations to treat PCOS seems appropriate because of their useful effects and low complications.

Aims

To assess the effects of probiotics, prebiotics, and synbiotics on hormonal indices such as testosterone, dehydroepiandrosterone sulfate (DHEA-S), sex hormone binding globulin, Free Androgen Index (FAI), and inflammatory indices, such as high sensitive C reactive protein (hsCRP), malondialdehyde (MDA), total glutathione (GSH), nitric oxide (NO), and total antioxidant capacity (TAC) as the primary outcomes and the hirsutism score as the secondary outcome.

Methods

All published articles from the beginning until 10 November 2018 in English (Cochrane Library, Web of Sciences, Google Scholar, PubMed, Scopus, and ProQuest) and Persian (SID and Magiran) databases were searched. The effect of interventions on the outcomes was reported with a standard mean difference (SMD) and confidence interval of 95%. In case of high heterogeneity, the random effect model was used instead of the fixed effect model. The statistical heterogeneity of the included clinical trials was tested using the Chi square test and I2.

Results

Thirteen studies with 855 participants with PCOS(438 women in the intervention group and 417 women in the control group) were included in the meta-analysis. Results of the meta-analysis showed that the SHBG (SMD: 0.56; 95% CI 0.26–0.86; P = 0.0002) and NO (SMD: 0.38; 95% CI 0.09–0.68; P = 0.01) concentration increased significantly in the probiotics and synbiotics groups compared to the placebo group. FAI (SMD: − 0.58; 95% CI − 0.95 to − 0.21; P = 0.002) and MDA (SMD: − 0.76; 95% CI − 1.46 to − 0.05; P = 0.03) concentration in the probiotics and synbiotics groups reduced significantly compared to the placebo group. The results of meta-analyses on other hormonal and inflammatory indices such as testosterone, DHEAS, GSH, hsCRP, TAC, and hirsutism score showed that there were no significant differences between the intervention and control groups.

Conclusion

Using synbiotics and probiotics in women with polycystic ovary syndrome improve hormonal (FAI, SHBG) and inflammatory (NO, MDA) indices in these patients.

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References

  1. Aalei Bibi SH, Naderi T (2004) Poly cystic ovarian syndrome: clinical, ultrasound and laboratory characteristics, Kerman. Iran J Endocrinol Metab 6(2):153–161

    Google Scholar 

  2. Speroff L, Mark AF (2011) Clinical gynecology endocrinology and infertility, 8th edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  3. Nadjarzadeh A, Dehghani Firouzabadi R, Vaziri N, Daneshbodi H, Lotfi MH, Mozaffari-Khosrav H (2013) The effect of omega-3 supplementation on androgen profile and menstrual status in women with polycystic ovary syndrome: a randomized clinical trial. Iran J Reprod Med 11(8):665–672

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Zhang J, Li T, Zhou L, Tang L, Xu L, Wu T et al (2010) Chinese herbal medicine for subfertile women with polycystic ovarian syndrome. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD007535.pub2/abstract

    Article  PubMed  Google Scholar 

  5. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 Consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81(1):19–25

    Google Scholar 

  6. Mehrabian F, Khani B, Kelishadi R, Ghanbari E (2011) The prevalence of poly cystic ovary syndrome in Iranian women based on different diagnostic criteria. EndoCrynol Polska 62(3):238–242

    Google Scholar 

  7. Kauffman RP, Baker VM, Dimarino P, Castracane VD (2002) Poly cystic ovarian syndrome and insulin resistance in white and Mexican American women: a comparison of two distinct population. An J Obstet Gynecol 187(5):1362–1369

    Google Scholar 

  8. Koivunen R, Laatikainen T, Tomas C, Huhtaniemi I, Tapanainen J, Martikainen H (1999) The prevalence of poly cystic ovaries in healthy women. Acta Obstet Gynecol Scand 78(2):137–141

    CAS  PubMed  Google Scholar 

  9. Balen AH, Rutherford AJ (2007) Managing anovulatory infertility and polycystic ovary syndrome. BMJ 335:663–669

    PubMed  PubMed Central  Google Scholar 

  10. Moran LJ, Ranasinha S, Zoungas S, McNaughton SA, Brown WJ, Teede HJ (2013) The contribution of diet, physical activity and sedentary behaviour to body mass index in women with and without polycystic ovary syndrome. Hum Reprod 28(8):2276–2283

    CAS  PubMed  Google Scholar 

  11. Bizzarri M, Carlomagno G (2014) Inositol: history of effective therapy for polycystic ovary syndrome. Eur Rev Med Pharmacol Sci 18:1896–1903

    CAS  PubMed  Google Scholar 

  12. Chittenden BG, Fullerton G, Maheshwari A, Bhattacharya S (2009) Polycystic ovary syndrome and the risk of gynaecological cancer: a systematic review. Reprod Biomed Online 19(3):398–405

    CAS  PubMed  Google Scholar 

  13. Meyer C, McGrath BP, Teede HJ (2005) Overweight women with polycystic ovary syndrome have evidence of subclinical cardiovascular disease. J Clin Endocrinol Metab 90(10):5711–5716

    CAS  PubMed  Google Scholar 

  14. Lobo RA (2001) Priorities in polycystic ovary syndrome. Med J Aust 174:554–555

    CAS  PubMed  Google Scholar 

  15. Moran Lisa J, Hutchison Samantha K, Norman Robert J, Teede Helena J (2011) Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 7:4. https://doi.org/10.1002/14651858.CD007506.pub3/abstract

    Article  Google Scholar 

  16. Salehpour S, Taherzadeh Broujeni P, Neisani Samani E (2008) Leptin, ghrelin, adiponectin, homocysteine and insulin resistance related to polycystic ovary syndrome. Int J Fertil Steril 2(3):101–104

    Google Scholar 

  17. Hoftman BH, Bradshaw KD, Cunningham FG, Halvorson LM, Schaffer JI, Schorge JO (2008) Williams gynecology. Mc Graw-Hill Medical, New York

    Google Scholar 

  18. Sheu J, Buzeny E, Reynolds R, Buzany C (2014) Polycystic ovary syndrome: a review for dermatologists: Part I. Diagn Manifest 71(5):912–919. https://doi.org/10.1016/j.amjmed.2014.04.017

    Article  Google Scholar 

  19. Schrezenmeir J, De Vaese M (2001) Probiotics, prebiotics, and synbiotics-approaching a definition. J Nutr 73:361–364

    Google Scholar 

  20. Scavuzzi BM, Hernique FC, Miglioranza LHS, Sinmao ANC, Dichi I (2014) Impact of prebiotics, probiotics and synbioticss on components of the metabolic syndrome. Ann Nutr Disord Ther 1(2):1009 (ISSN: 2381-8891)

    Google Scholar 

  21. Roberfroid B, Bornet F, Bouley C, Cummings JH (1995) Colonic microflora:nutrition and health: summary and conclusions of an International Life Sciences Institute (ILSI) [Europe] workshop held in Barcelona, Spain. Nutr Rev 53(5):127–130

    CAS  PubMed  Google Scholar 

  22. Paineau D, Payen F, Panserieu S, Coulombier G, Sobaszek A, Lartigau I et al (2008) The effects of regular consumption of short-chain fructo-oligosaccharides on digestive comfort of subjects with minor functional bowel disorders. Br J Nutr 99(2):311–318

    CAS  PubMed  Google Scholar 

  23. Ooi LG, Liong MT (2010) Cholesterol-lowering effects of probiotics and prebiotics: a review of in vivo and in vitro findings. Int J Mol Sci 11(6):2499–2522. https://doi.org/10.3390/ijms11062499

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Scholz-Ahrens KE, Schrezenmeir JR (2007) Inulin and oligofructose and mineral metabolism: the evidence from animal trials. J Nutr 137(11):2513S–2523S

    CAS  PubMed  Google Scholar 

  25. Scavuzzi BM, Hernique FC, Miglioranza LHS, Sinmao ANC, Dichi I (2014) Impact of prebiotics, probiotics and synbioticss on components of the metabolic syndrome. Ann Nutr Disord and Ther 1(2):1009 (ISSN: 2381-8891)

    Google Scholar 

  26. Greg Kelly N (2009) Inulin-type prebiotics: review (part2). Altern Med Rev 14(1):36–55

    PubMed  Google Scholar 

  27. Homayouni Rad A (2008) Therapeutical effects of functional probiotic, prebiotic and synbiotics foods, 1st edn. Tabriz University of Medical Sciences, Tabriz

    Google Scholar 

  28. Goldin BR, Gorbach SL (2008) Clinical indications for probiotics: an overview. Clin Infect Dis 46(2):96–100

    Google Scholar 

  29. Begley M, Hill C, Gahan CGM (2006) Bile salt hydrolase activity in probiotics. Appl Environ Microbiol 72(3):1729–1738

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Oelschlaeger T (2010) Mechanisms of probiotic actions—a review. Int J Med Microbiol 300(1):57–62

    CAS  PubMed  Google Scholar 

  31. Flint H, Bayer E, Rincon M, Lamed R, White B (2008) Polysaccharide utilization by gut bacteria: potential for new insights from genomic analysis. Nat Rev Microbiol 6(2):121–131

    CAS  PubMed  Google Scholar 

  32. Gibson GR, Roberfroid MB (1995) Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. J Nutr 125(6):1401–1412

    CAS  PubMed  Google Scholar 

  33. Fooks LJ, Gibson GR (2002) Probiotics as modulators of the gut flora. Br J Nutr 88(1):S39–S49

    CAS  PubMed  Google Scholar 

  34. Su P, Henriksson A, Mitchell H (2007) Prebiotics enhance survival and prolong the retention period of specific probiotic inocula in an in vivo murine model. J Appl Microbiol 103(6):2392–2400

    CAS  PubMed  Google Scholar 

  35. Karamali M, Eghbalpour S, Rajabi S, Jamilian M et al (2018) Effects of probiotic supplementation on hormonal profiles, biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome: a randomized, double blind, placebo-controlled trial. Arch Iran Med 21(1):1–7

    PubMed  Google Scholar 

  36. Ghanei N, Rezaei N, Amiri GA, Zayeri F, Makki G, Nasseri E (2018) The probiotic supplementation reduced inflammation in polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial. J Funct Food 42:306–311

    CAS  Google Scholar 

  37. Gholizadeh-Shamasbi S, Dehgan P, Mohammad-Alizadeh S, Aliasgarzadeh A, Mirghafourvand M (2018) The effect of resistant dextrin as a prebiotic on metabolic parameters and androgen level in women with polycystic ovarian syndrome: a randomized, triple-blind, controlled, clinical trial. Euro J Nutr. https://doi.org/10.1007/s00394-018-1648-7

    Article  Google Scholar 

  38. Jamilian M, Mansury Sh, Bahmani F, Heidar Z, Amirani E, Asemi Z (2018) The effects of probiotic and selenium cosupplementation on parameters of mental health, hormonal profiles, and biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome. J Ovarian Res 11:80. https://doi.org/10.1186/s13048-018-0457-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Esmaeilinezhad Z, Babajafari S, Sohrabi Z, Eskandari M-H, Amooee S, Barati-Boldaji R (2018) Effect of synbiotics pomegranate juice on glycemic, sex hormone profile and anthropometric indices in PCOS: a randomized, triple blind, controlled trial. Nut Metab Cardiovasc Dis. https://doi.org/10.1016/j.numecd.2018.07.002

    Article  Google Scholar 

  40. Nasri Kh, Jamilian M, Asemi Z, Rahmani E, Bahmani F, Tajabadi-Ebrahimi M (2018) The effects of synbiotics supplementation on hormonal status, biomarkers of inflammation and oxidative stress in subjects with polycystic ovary syndrome: a randomized, double-blind, placebocontrolled trial. BMC Endocr Disord 18:21. https://doi.org/10.1186/s12902-018-0248-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0. Wiley, Chichester

    Google Scholar 

  42. Samimi M, Seyed Hosseini E, Dadkhah A, Asemi Z (2018) The effects of synbiotics supplementation on metabolic status in women with polycystic ovary syndrome: a randomized double-blind clinical trial. Probiot Antimicrob Proteins. https://doi.org/10.1007/s12602-018-9405-z

    Article  Google Scholar 

  43. Karimi E, Moini A, Yaseri M, Shirzad N, Sepidarkish M, Hossein-Boroujerdi M, Hosseinzadeh-Attar MJ (2018) Effects of synbiotics supplementation on metabolic parameters and apelin in women with polycystic ovary syndrome: a randomised double-blind placebo-controlled trial. Br J Nutr 119(4):398–406. https://doi.org/10.1017/S0007114517003920

    Article  CAS  PubMed  Google Scholar 

  44. Ahmadi Sh, Jamilian M, Karamali M, TajabadiEbrahimi M, Jafari P, Taghizadeh M, Memarzadeh MR, Asemi Z (2017) Probiotic supplementation and the effects on weight loss, glycaemia and lipid profiles in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial. Hum Fertil 20(4):254–261. https://doi.org/10.1080/14647273.2017.1283446

    Article  CAS  Google Scholar 

  45. Shoaei T, Heidari-Beni M, Ghasemi Tehrani H, Feizi A, Esmaillzadeh A, Askari Gh (2015) Effects of probiotic supplementation on pancreatic β-cell function and C-reactive protein in women with polycystic ovary syndrome: a randomized double-blind placebo-controlled clinical trial. Int J Prev Med 6:27. https://doi.org/10.4103/2008-7802.153866

    Article  PubMed  PubMed Central  Google Scholar 

  46. Shabani A, Noshadian M, Jamilian M, Chamani M, Mohammadi S, Asemi Z (2018) The effects of a novel combination of selenium and probiotic on weight loss, glycemic control and markers of cardio-metabolic risk in women with polycystic ovary syndrome. J Funct Foods 46:329–334

    CAS  Google Scholar 

  47. Rashad NM, El-Shal AS, Amin AI, Soliman MH (2017) Effects of probiotics supplementation on macrophage migration inhibitory factor and clinical laboratory feature of polycystic ovary syndrome. J Funct Foods 36:317–324

    CAS  Google Scholar 

  48. Gholizadeh-Shamasbi S, Dehgan P, Mohammad-Alizadeh S, Aliasgarzadeh A, Mirghafourvand M (2018) Effect of prebiotic on anthropometric indices in women with polycystic ovarian syndrome: a triple-blind, randomized, controlled clinical trial. Iran Red Crescent Med J 20(11):67270

    Google Scholar 

  49. Api M, Badoglu B, Akca A, Api O, Gorgen H, Cetin A (2008) Interobserver variability of modified Ferriman–Gallwey hirsutism score in a Turkish population. Arch Gynecol Obstet 279(4):473–479. https://doi.org/10.1007/s00404-008-0747-8

    Article  PubMed  Google Scholar 

  50. Khajebishak Y, Payahoo L, Homayouni Rad A, Shokrvash B (2014) The role of intestinal microbiota in health and a short review on the probiotic and prebiotic supplements in obesity prevention. Arak Med Univ J 17(90):18–26

    Google Scholar 

  51. Pan C, Zhao Y, Liao SF, Chen F, Qin S, Wu X et al (2011) Effect of selenium enriched probiotics on laying performance, egg quality, egg selenium content, and egg glutathione peroxidase activity. J Agric Food Chem 59(21):11424–11431

    CAS  PubMed  Google Scholar 

  52. Aliasgharzadeh A, Khalili M, Mirtaheri E, Pourghassem Gargari B, Tavakoli F, Abbasalizadeh Farhangi M et al (2015) A combination of prebiotic inulin and oligofructose improve some of cardiovascular disease risk factors in women with type 2 diabetes: a randomized controlled clinical trial. Adv Pharm Bull 5(4):507–514

    CAS  PubMed  PubMed Central  Google Scholar 

  53. Amiri M, Golsorkhtabaramiri M, Esmaeilzadeh S, Ghofrani F, Bijani A, Ghorbani L et al (2014) Effect of metformin and flutamide on anthropometric indices and laboratory tests in obese/overweight PCOS women under hypocaloric diet. J Reprod Infertil 15(4):205–213

    PubMed  PubMed Central  Google Scholar 

  54. Carvalho BM, Abdalla Saad MJ (2013) Influence of gut microbiota on subclinical inflammation and insulin resistance. Mediators Inflamm 2013:986734. https://doi.org/10.1155/2013/986734

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Mehdizadeh ZT, Mirfeizi M, Mirfeizi Z, Asghari MJ, Hojat SH (2013) The effect of diet and physical activity on obese women with polycystic ovary syndrome. Med J Mashhad 56(2):77–84. https://doi.org/10.22038/MJMS.2013.846

    Article  Google Scholar 

  56. Huang A, Brennan K, Azziz R (2010) Prevalence of hyperandrogenemia in the polycystic ovary syndrome diagnosed by the National Institutes of Health 1990 criteria. Fertil Steril 93(6):1938–1941

    PubMed  Google Scholar 

  57. Wehr E, Moller R, Horejsi R, Giuliani A, Kopera D, Schweighofer N et al (2009) Subcutaneous adipose tissue topography and metabolic disturbances in polycystic ovary syndrome. Wien Klin Wochenschr 121(7–8):262–269

    PubMed  Google Scholar 

  58. West S, Lashen H, Bloigu A, Franks S, Puukka K, Ruokonen A et al (2014) Irregular menstruation and hyperandrogenaemia in adolescence are associated with polycystic ovary syndrome and infertility in later life: northern Finland birth cohort 1986 study. Hum Reprod 29(10):2339–2351

    CAS  PubMed  PubMed Central  Google Scholar 

  59. Gonzalez F (2015) Nutrient-induced inflammation in polycystic ovary syndrome: role in the development of metabolic aberration and ovarian dysfunction. Semin Reprod Med 33(4):276–286

    CAS  PubMed  Google Scholar 

  60. Zuo T, Zhu M, Xu W (2016) Roles of oxidative stress in polycystic ovary syndrome and cancers. Oxid Med Cell Longev 2016:8589318

    PubMed  Google Scholar 

  61. Sathyapalan T, Shepherd J, Coady AM, Kilpatrick ES, Atkin SL (2012) Atorvastatin reduces malondialdehyde concentrations in patients with polycystic ovary syndrome. J Clin Endocrinol Metab 97(11):3951–3955

    CAS  PubMed  Google Scholar 

  62. Diamanti-Kandarakis E, Paterakis T, Alexandraki K, Piperi C, Aessopos A, Katsikis I et al (2006) Indices of low-grade chronic inflammation in polycystic ovary syndrome and the beneficial effect of metformin. Hum Reprod 21(6):1426–1431

    CAS  PubMed  Google Scholar 

  63. Xue Q, Yan Y, Zhang R, Xiong H (2018) Regulation of iNOS on immune cells and its role in diseases. Int J Mol Sci 19:3805–3818. https://doi.org/10.3390/ijms19123805

    Article  CAS  PubMed Central  Google Scholar 

  64. Szkudelski T (2001) The mechanism of alloxan and streptozotocin action in B cells of the rat pancreas. Physiol Res 50:537–546

    CAS  PubMed  Google Scholar 

  65. Shakeri H, Hadaegh H, Abedi F et al (2014) Consumption of synbiotics bread decreases triacylglycerol and VLDL levels while increasing HDL levels in serum from patients with type 2 diabetes. Lipids 49(7):695–701

    CAS  PubMed  Google Scholar 

  66. Wang Y, Li Y, Xie J et al (2013) Protective effects of probiotic lactobacillus casei Zhang against endotoxin- and d-galactosamine-induced liver injury in rats via anti-oxidative and anti-inflammatory capacities. Int Immunopharmacol 15(1):30–37

    CAS  PubMed  Google Scholar 

  67. Wang Y, Wu Y, Wang Y, Xu H, Mei X, Yu D et al (2017) Antioxidant properties of probiotic bacteria. Nutrients 9(5):521. https://doi.org/10.3390/nu9050521

    Article  CAS  PubMed Central  Google Scholar 

  68. Sadrzadeh-Yeganeh H, Elmadfa I, Djazayery A, Jalali M, Heshmat R, Chamary M (2010) The effects of probiotic and conventional yoghurt on lipid profile in women. Br J Nutr 103(12):1778–1783. https://doi.org/10.1017/s0007114509993801

    Article  CAS  PubMed  Google Scholar 

  69. Cani PD, Possemiers S, Van de Wiele T et al (2009) Changes in gut microbiota control inflammation in obese mice through a mechanism involving GLP-2-driven improvement of gut permeability. Gut 58(8):1091–1103

    CAS  PubMed  PubMed Central  Google Scholar 

  70. Suzuki A, Mitsuyama K, Koga H et al (2006) Bifidogenic growth stimulator for the treatment of active ulcerative colitis: a pilot study. Nutrition 22(1):76–81

    CAS  PubMed  Google Scholar 

  71. Rishi P, Mavi SK, Bharrhan S et al (2009) Protective efficacy of probiotic alone or in conjunction with a prebiotic in Salmonella-induced liver damage. FEMS Microbiol Ecol 69(2):222–230

    CAS  PubMed  Google Scholar 

  72. Heshmati J, Farsi F, Yosaee S, Razavi M, Rezaeinejad M, Karimie E, Sepidarkish M (2018) The effects of probiotics or synbiotics supplementation in women with polycystic ovarian syndrome: a systematic review and meta-analysis of randomized clinical trials. Probiot Antimicro Prot. https://doi.org/10.1007/s12602-018-9493-9

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran

    Sevda Gholizadeh Shamasbi

  2. Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

    Solmaz Ghanbari-Homayi

  3. Midwifery Department, Social Determinants of Health Research Center, Tabriz University of Medical Sciences, P.O. Box: 51745-347, Tabriz, 513897977, Iran

    Mojgan Mirghafourvand

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  1. Sevda Gholizadeh Shamasbi
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SGS, SGH, and MM participated in the study design. SGS and SGH searched the literature and selected studies, extracted data, assessed quality, and SGS drafted the manuscript. MM revised the draft and all authors read and approved the final version of the manuscript.

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Correspondence to Mojgan Mirghafourvand.

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Shamasbi, S.G., Ghanbari-Homayi, S. & Mirghafourvand, M. The effect of probiotics, prebiotics, and synbiotics on hormonal and inflammatory indices in women with polycystic ovary syndrome: a systematic review and meta-analysis. Eur J Nutr 59, 433–450 (2020). https://doi.org/10.1007/s00394-019-02033-1

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Keywords

  • Probiotic
  • Symbiotic
  • Prebiotic
  • Polycystic ovary syndrome
  • Systematic review
  • Meta-analysis