Nutrition Reviews · Oct 30, 2026
Effect of Energy Restriction Combined with Probiotic Supplementation on Body Weight and Adiposity-Related Parameters in Adults with Overweight or Obesity: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
By Dos Santos Quaresma MVL, Marques CG, Magalhães ACO et al.
CONTEXT: Gut microbiota modulation has been proposed as an adjunct strategy for obesity management, but the additional effects of probiotics during energy restriction (ER) remain uncertain. OBJECTIVE: To determine whether probiotic supplementation combined with ER improves body weight and adiposity-related outcomes in adults with overweight or obesity compared with ER alone. DATA SOURCES: This systematic review and meta-analysis followed the PRISMA guidelines and was prospectively registered in PROSPERO. PubMed, Embase, Cochrane CENTRAL, and LILACS were searched through August 2025 for randomized controlled trials comparing ER plus probiotics with ER alone or ER plus placebo. DATA EXTRACTION: Two reviewers independently screened the studies and extracted the data. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence using GRADE. The primary outcome was body weight (BW); secondary outcomes were Body Mass Index (BMI), fat mass (FM), body fat percentage (BF%), waist circumference (WC), and fat-free mass (FFM). DATA ANALYSIS: Nineteen randomized controlled trials involving 1343 participants were included, of which 16 contributed to the meta-analysis. Interventions lasted 3-20 weeks, probiotic doses ranged from 1.8 × 106 to 1.5 × 1011 colony-forming units / day, and ER ranged from fixed deficits of 300-1000 kcal/day to relative reductions of 20% to 30%. Random-effects models showed no additional effect of probiotics on BW (mean difference [MD], -0.41 kg; 95% CI, -1.21 to 0.40), BMI (-0.12 kg/m²; -0.39 to 0.15), BF% (-0.63%; -1.52 to 0.26), WC (-0.33 cm; -1.06 to 0.39), or FFM (0.03 kg; -0.18 to 0.24). A small reduction in FM favored ER plus probiotics (-0.34 kg; -0.60 to -0.08; P = .016) and remained significant after excluding high-risk-of-bias studies. CONCLUSION: Adding probiotics to ER does not meaningfully enhance weight loss or body composition outcomes. Although FM was modestly reduced, the magnitude of the reduction was small, and its clinical relevance remains uncertain across the included randomized clinical trials overall. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration No. CRD42024619326.