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Clinical Nutrition 33 (2014) 198e203

Contents lists available at SciVerse ScienceDirect

Clinical Nutrition
journal homepage: http://www.elsevier.com/locate/clnu

Randomized control trials

Effects of synbiotic food consumption on metabolic status of diabetic


patients: A double-blind randomized cross-over controlled clinical
trial
Zatollah Asemi a, Ashraf Khorrami-Rad b, Sabihe-Alsadat Alizadeh c, Hossein Shakeri a,
Ahmad Esmaillzadeh d, e, *
a
Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
b
Department of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
c
Department of Research and Development of Sekkeh Gaz Company, Isfahan, Iran
d
Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
e
Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran

a r t i c l e i n f o s u m m a r y

Article history: Background & aims: We are aware of no study indicating the effects of synbiotic food consumption on
Received 12 January 2013 metabolic proles, inammation and oxidative stress among diabetic patients. The aim of the current
Accepted 23 May 2013 study was to investigate the effects of synbiotic food consumption on metabolic proles, hs-CRP and
biomarkers of oxidative stress in diabetic patients.
Keywords: Methods: This randomized double-blinded cross-over controlled clinical trial was performed among 62
Synbiotic
diabetic patients aged 35e70 y. After a 2-wk run-in period, subjects were randomly assigned to consume
Plasma glucose
either a synbiotic (n 62) or control food (n 62) for 6 weeks. A 3-week washout period was applied
Insulin
Inammation
following which subjects were crossed over to the alternate treatment arm for an additional 6 weeks. The
Oxidative stress synbiotic food consisted of a probiotic viable and heat-resistant Lactobacillus sporogenes (1  107 CFU),
Diabetes 0.04 g inulin (HPX) as prebiotic with 0.38 g isomalt, 0.36 g sorbitol and 0.05 g stevia as sweetener per 1 g.
Control food (the same substance without probiotic bacteria and prebiotic inulin) was packed in identical
9-gram packages. Patients were asked to consume the synbiotic and control foods three times a day.
Fasting blood samples were taken at baseline and after a 6-wk intervention to measure metabolic
proles, hs-CRP and biomarkers of oxidative stress.
Results: Consumption of a synbiotic food, compared to the control, resulted in a signicant decrease in
serum insulin levels (changes from baseline: 1.75  0.60 vs. 0.95  1.09 mIU/mL, P 0.03). Although
we failed to nd a signicant effect of synbiotic food consumption on total- and LDL-cholesterol levels
and HOMA-IR, the effects on FPG (22.3 vs. 4.2 mg/dL, P 0.09), serum triglycerides (45.9 vs. 20.6 mg/dL,
P 0.08) and HDL-cholesterol levels (3.1 vs. 2 mg/dL, P 0.06) tended to be signicant. A signicant
reduction in serum hs-CRP levels (1057.86  283.74 vs. 95.40  385.38 ng/mL, P 0.01) was found
following the consumption of synbiotic food compared with the control group. Supplementation with
the synbiotic food led to a signicant increase in plasma total GSH (319.98 vs. 19.73 mmol/L, P < 0.001)
and serum uric acid levels (0.7 vs. 0.1 mg/dL, P 0.04) compared to the control food. No signicant
effect of the synbiotic food was observed on plasma TAC levels.
Conclusions: In conclusion, consumption of a synbiotic food for 6 weeks among diabetic patients had
signicant effects on serum insulin, hs-CRP, uric acid and plasma total GSH levels.
Clinical trial registration number: www.irct.ir: IRCT201201195623N1.
2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

1. Introduction

* Corresponding author. Department of Community Nutrition, School of Nutrition Type 2 diabetes (T2D) is a metabolic disorder that is character-
and Food Science, Isfahan University of Medical Sciences, PO Box 81745-151, Isfa-
ized by high blood glucose levels, insulin resistance and relative
han, Iran. Tel.: 98 311 7922720; fax: 98 311 6682509.
E-mail addresses: Esmaillzadeh@hlth.mui.ac.ir, a.esmaillzadeh@gmail.com insulin deciency.1 Diabetes is highly prevalent in the world with
(A. Esmaillzadeh). an estimated prevalence of 8.3% in US.2 In Iran, it has been

0261-5614/$ e see front matter 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
http://dx.doi.org/10.1016/j.clnu.2013.05.015
Z. Asemi et al. / Clinical Nutrition 33 (2014) 198e203 199

estimated that 8% of adult population are affected.3 Several studies 2.2. Study design
have reported that increased levels of inammatory factors and
biomarkers of oxidative stress can result in the development of To obtain detailed information about the dietary intakes of
T2D. Elevated inammation and oxidative stress can also play a key study participants, all patients entered into a 2-wk run-in period;
role in the pathogenesis of both macro- and micro-vascular com- during which all subjects had to refrain from taking any other
plications of diabetes.4 synbiotic and probiotic foods. During the run-in period, partici-
Prior studies have shown that decreasing circulating levels of pants were asked to record their dietary intakes for three non-
pro-inammatory factors and biomarkers of oxidative stress in consecutive days. At the end of run-in period, subjects were
diabetic patients are associated with better glycemic control. The randomly assigned to the initial arm of the study to receive either a
effectiveness of diet therapy and antioxidant supplementation and synbiotic or control food for 6 weeks. A 3-week washout period was
high tness levels on these biomarkers has been reported.5 Some applied following which subjects were crossed over to the alternate
studies have suggested that consumption of synbiotic foods might treatment arm for an additional 6 weeks. Participants were asked
help controlling the metabolic prole, inammatory factors6 and not to alter their routine physical activity or usual diets and not to
biomarkers of oxidative stress.7 However, such effects have mainly consume any synbiotic, probiotic and fermented products other
been observed in animal models or non-diabetic patients. Liong than the one provided to them by the investigators. Synbiotic or
et al.8 showed that intake of a synbiotic containing Lactobacillus control foods were provided to participants every month. Compli-
acidophilus, fructooligosaccharide, inulin and mannitol for 8 weeks ance with the consumption of foods was monitored once a week
resulted in a decreased serum triglyceride, total- and LDL- through phone interviews. The compliance was also double-
cholesterol levels as well as increased HDL-cholesterol concentra- checked by the use of three-day dietary records completed
tions in hypercholesterolaemic pigs. In addition, increased levels of throughout the study in each phase of intervention. To obtain
superoxide dismutase and glutathione, along with reduced levels of nutrient intakes of participants based on these three-day food di-
nitric oxide have been reported with a consumption of synbiotic aries in each phase, we used Nutritionist IV software (First Data-
containing L. acidophilus and inulin in a murine model.9 Synbiotics bank, San Bruno, CA) modied for Iranian foods.
inuence the production of short chain fatty acid (SCFA), carbon
disulde and methyl acetate,10 and can increase the lipolytic ac- 2.3. Synbiotic and control foods
tivity. Their direct immunomodulatory effects11 as well as down-
regulatory inuence on genes involved in toll-like receptor (TLR) The synbiotic food consisted of a probiotic viable and heat-
pathways might explain their favorable actions.12 Due to their ef- resistant Lactobacillus sporogenes (1  107 CFU), 0.04 g inulin
fects on caveolin-1, endothelial NOS and neuronal NOS down- (HPX) as prebiotic with 0.38 g isomalt, 0.36 g sorbitol and 0.05 g
regulation,7 synbiotics might affect oxidative stress.13 stevia as sweetener per 1 g. Patients were asked to consume the
We are aware of no study indicating the effects of synbiotic food synbiotic food three times a day in a 9 g package. Therefore, they
consumption on metabolic proles, inammation and oxidative received 27  107 CFU L. sporogenes and 1.08 g inulin each day.
stress among diabetic patients. The aim of the current study was, Control food (the same substance without probiotic bacteria and
therefore, to investigate the effects of a synbiotic food on metabolic prebiotic inulin) was packed in identical packages and coded by the
proles, hs-CRP and biomarkers of oxidative stress in diabetic producer to guarantee blinding. The synbiotic and control foods
patients. were provided by Sekkeh Gaz Company, Isfahan, Iran.
The probiotic effects of L. sporogenes have earlier been shown.15
2. Subjects and methods Although different studies have used different dosages of the pro-
biotics, we used it at the dosage of 107 based on prior publications
2.1. Participants that indicated the efcacy of this dosage of L. sporogenes on lipid
proles.15 The dosage of inulin we used in the current study was
This randomized double-blinded crossover controlled clinical comparable to prior studies.16
trial was carried out in Kashan, Iran, during July 2011 to January
2012. On the basis of sample size formula suggested for cross-over 2.4. Assessment of variables
clinical trials,14 we considered the type I error of 5% (a 0.05) and
type II error of 20% (b 0.20; Power 80%) and serum hs-CRP Anthropometric measurements were assessed at baseline and
levels as a key variable and reached the sample size of 23 pa- after 6 weeks of intervention in each separate arm. Body weight
tients for each group. Diagnosis of T2D was done based on the was measured in an overnight fasting status, without shoes and in a
criteria of American Diabetes Association1: those with one of the minimal clothing state by the use of a digital scale (Seca, Hamburg,
following criteria were considered as having T2D: fasting plasma Germany) to the nearest 0.1 kg. Height was measured using a non-
glucose (FPG) 126 mg/dL, blood sugar (BS) 2-h pp 200 mg/dL stretched tape measure (Seca, Hamburg, Germany) to the nearest
and HbA1C 6.5%. Individuals with the above-mentioned inclusion 0.1 cm. BMI was calculated as weight in kg divided by height in
criteria were called for participation in the study from those that meters squared. Fasting blood samples (10 mL) were taken at
attended Golabchi Diabetes Clinic afliated to Kashan University of baseline and after 6-wk intervention in each separate arm at
Medical Sciences, Kashan, Iran. Subjects were not included if they Kashan reference laboratory in an early morning after an overnight
were pregnant, using insulin or vitamin supplements, or had fast. Plasma glucose levels were quantied by the use of glucose
chronic kidney disease, liver, lung and chronic or acute inamma- oxidase/peroxidase (GOD-POD) method with commercially avail-
tory disease, heart valve disease, short bowel syndrome and al- able kits (Pars Azmoon Inc, Tehran, Iran). Serum insulin levels were
lergies. A total of 70 patients with T2D aged 35 to 70 y were assayed by enzyme-linked immunoassay kits (DiaMetra, Italy). In-
recruited in the study and were randomly assigned to receive either sulin resistance was assessed using the homeostatic model
a synbiotic (n 35) or control food (n 35) for 6 weeks. The study assessment of insulin resistance (HOMA-IR). Serum total choles-
was conducted according to the guidelines laid down in the terol and triacylglycerol concentrations were assayed using com-
Declaration of Helsinki. The ethical committee of Qom University of mercial kits (Pars Azmoon Inc, Tehran, Iran) by enzymatic
Medical Sciences approved the study (91288-91-7-5) and informed colorimetric tests with cholesterol oxidase p-aminophenazone and
written consent was obtained from all participants. glycerol phosphate oxidase, respectively. Serum HDL-C levels were
200 Z. Asemi et al. / Clinical Nutrition 33 (2014) 198e203

measured after precipitation of the apolipoprotein B containing of the two treatment orders by t test. To assess if the magnitude of
lipoproteins with phosphotungistic acid. Serum LDL-cholesterol the change depended on the starting value, we conditioned all
levels were also measured using available kits. Serum hs-CRP was analyses on baseline values to avoid the potential bias that might
quantied by ELISA using enzyme linked immunoassay kits (LDN, have resulted. All statistical analyses were done using the Statis-
Nordhorn, Germany). Plasma samples were analyzed for concen- tical Package for Social Science version 17 (SPSS Inc., Chicago,
trations of TAC and total glutathione levels. Plasma TAC was Illinois, USA).
assessed by the use of FRAP method developed by Benzie and
Strain.17 The plasma total GSH was measured by the method of 3. Results
Beutler et al.17 Serum uric acid concentrations were assayed using
uric acid kit (Pars Azmoon Inc, Tehran, Iran). Of the 70 participants enrolled in the study, 62 patients (19
males and 43 females) completed the entire crossover study.
2.5. Statistical analysis Among individuals in synbiotic food group, 4 persons [chronic
kidney disease (n 1), need to insulin therapy (n 1), supplement
To ensure the normal distribution of variables, Histogram and therapy (n 1) and increased need to medications (1)] were
KolmogroveSmirnov test were applied. For non-normally dropped out. The exclusions in the control group were also 4 pa-
distributed variables, log-transformation was applied. Descrip- tients [need to antibiotic treatment (n 1), need to insulin therapy
tive statistics (means, SEMs and range) for general characteristics (n 2) and supplement therapy (n 1)]. Finally, 62 participants
of the study participants were reported. Data on dietary intakes [synbiotic group (n 62) and control group (n 62)] completed the
were compared by paired t-test. To determine the effect of syn- trial (Fig. 1). Mean age and duration of diabetes was 53.1  8.7 y and
biotic food on metabolic proles, we applied repeated measures 8.0  4.1 y, respectively.
analysis of variance. In these analyses, the treatments (synbiotic No serious adverse reactions were reported following the con-
and control foods) were regarded as between-subject factors and sumption of the synbiotic food in patients with T2D throughout the
time was considered as within-subject factor. To assess carry-over study. Comparing the anthropometric measures at baseline and
effect, we computed the average of end-of-trial values for each also after intervention, we failed to nd a signicant difference in
variable for two treatments separately and compared the means weight and BMI between the two groups (Table 1).

Response to advertisement
n=90

Ineligible subjects by screening


for inclusion criteria
n=20
Eligible for participation
n=70

Run-in period
n=70

Synbiotic food Control food


n=35 n=35

Withdrawals (n=4) Withdrawals (n=4)


Kidney disease (n=1) Antibiotic use (n=1)
Supplement use (n=1) Insulin therapy (n=2)
Insulin therapy (n=1) Supplement use (n=1)
Increased need to Washout period
medications (n=1 n=62

Control Food Synbiotic food


n=31 n=31

Completed the trial and analyzed


n=62

Fig. 1. Patient ow diagram.


Z. Asemi et al. / Clinical Nutrition 33 (2014) 198e203 201

Table 1 Table 2
General characteristics of the study participants.a Dietary intakes of study participants throughout the study.a

Control Synbiotic food Pb Throughout the study


(n 62) (n 62)
Control Synbiotic food Pb
Weight at study baseline (kg) 75.42  11.96 74.88  11.27 0.78 (n 62) (n 62)
Weight at end-of-trial (kg) 75.39  12.09 74.76  11.53 0.75
Energy (kcal/d) 2205  293 2237  215 0.59
Weight change 0.03  2.44 0.12  1.57 0.82
Fat (g/d) 94.9  22.2 98.7  21.8 0.46
BMI at study baseline (kg/m2) 29.90  5.18 29.60  4.53 0.70
SFAc (g/d) 20.9  4 22.8  5.1 0.08
BMI at end-of-trial (kg/m2) 29.88  5.19 29.55  4.54 0.66
PUFAd (g/d) 43.2  14.6 43.2  11.4 0.99
BMI change 0.02  1 0.05  0.62 0.78
MUFAe (g/d) 24.2  1.5 26  1.5 0.37
a
Data are means  standard deviation. Cholesterol (mg/d) 191.8  100.5 192.7  96.2 0.97
b
Paired t-test. Dietary ber (g/d) 16.1  4 15.8  3 0.70
Vitamin C (mg/d) 153.1  57.1 171.4  77 0.25
Selenium (mg/d) 73.60  20.04 75.10  22.03 0.76
Based on the three-day dietary records throughout the study, no a
Data are means  standard deviations.
b
statistically signicant difference was seen between the two groups Obtained from paired t test.
c
in terms of dietary intakes of energy, fat, saturated fatty acids (SFA), SFA: saturated fatty acid.
d
PUFA: poly-unsaturated fatty acid.
poly unsaturated fatty acids (PUFA), mono-unsaturated fatty acids e
MUFA: mono unsaturated fatty acid.
(MUFA), cholesterol, dietary ber, vitamin C and selenium (Table 2).
Consumption of a synbiotic food, compared to the control,
resulted in a signicant decrease in serum insulin levels (changes serum insulin, hs-CRP, uric acid and plasma total GSH levels;
from baseline: 1.75  0.60 vs. 0.95  1.09 mIU/mL, P 0.03) however, we failed to nd any signicant effect on plasma TAC
(Table 3). Although we failed to nd a signicant effect of synbiotic levels compared to control food. To the best of our knowledge, this
food consumption on total- and LDL-cholesterol levels and HOMA- study is the rst examining the effect of synbiotic food on metabolic
IR, the effects on FPG (22.3 vs. 4.2 mg/dL, P 0.09), serum tri- status of diabetic patients.
glycerides (45.9 vs. 20.6 mg/dL, P 0.08) and HDL-cholesterol Patients with T2D are susceptible to metabolic abnormalities,
levels (3.1 vs. 2 mg/dL, P 0.06) were tended to be signicant. elevated systemic inammation and oxidative stress. Several
A signicant reduction in serum hs-CRP levels (1057.86  283.74 studies have shown that increased inammation and oxidative
vs. 95.40  385.38 ng/mL, P 0.01) was found following the con- stress in diabetic patients can contribute to the development of
sumption of synbiotic food compared with the control group. diabetes complications such as retinopathy, neuropathy and ne-
Supplementation with synbiotic food led to a signicant increase in phropathy.4 Although several attempts have been done to prevent
plasma total GSH (319.98 vs. 19.73 mmol/L, P < 0.001) and serum the incidence of diabetes complications, limited data are available
uric acid levels (0.7 vs. 0.1 mg/dL, P 0.04) compared to the assessing the effects of synbiotic foods. However, earlier studies on
control food. No signicant effect of synbiotic food was observed on the effects of synbiotics have mostly been assessed in vitro10 and
plasma TAC levels. When we adjusted the analyses for baseline patients with multiple injuries.11 We demonstrated that intake of
values, no signicant changes in our ndings were observed (Data synbiotic food resulted in signicantly decreased serum insulin
not shown). levels as well as marginally increased serum HDL-cholesterol
levels, but could not affect plasma glucose, serum total- and LDL-
4. Discussion cholesterol levels. Earlier studies reported that supplementation
with probiotics18 and inulin as a prebiotic19 led to reduced insulin
This cross-over study revealed that consumption of synbiotic levels. The use of a synbiotic food containing L. acidophilus, fructo-
food for 6 weeks among diabetic patients had signicant effects on oligosaccharide, inulin and mannitol has resulted in decreased

Table 3
Means (standard error) of metabolic proles, hs-CRP and biomarkers of oxidative stress at baseline and after the intervention.

Control (n 62) Synbiotic food (n 62) Pa

Wk0 Wk6 Change Wk0 Wk6 Change

FPGb (mg/dL) 168.4  8.1 172.6  8.3 4.2  7 147.9  8.4 170.2  8.9 22.3  7.9 0.09
Insulin (mIU/mL) 8.08  0.59 9.03  1.08 0.95  1.09 8.80  0.70 7.05  0.51 1.75  0.60 0.03
HOMA-IRc 3.27  0.25 3.96  0.60 0.69  0.52 3.05  0.28 2.91  0.25 0.14  0.30 0.17
Total cholesterol (mg/dL) 175.7  6.8 183.5  6.9 7.8  6 160.5  6.9 183.5  5.6 22.9  7.3 0.11
Triglycerides (mg/dL) 169.9  12 190.5  14.9 20.6  9.9 137.3  9.7 183.2  12.5 45.9  10.8 0.08
LDL-cholesterold (mg/dL) 91.4  4.5 97  5 5.6  3.4 89.5  4.5 100.2  4 10.7  4.9 0.42
HDL-cholesterole (mg/dL) 50.3  1.9 48.3  1.4 2  2 43.6  1.8 46.7  1.3 3.1  1.8 0.06
Total: HDL cholesterol ratio 3.6  0.9 3.9  0.9 0.3  0.1 3.8  0.1 4  0.1 0.2  0.1 0.97
hs-CRPf (ng/mL) 1897.75  360.22 1993.15  331.95 95.40  385.38 2039.35  335.08 981.49  131.19 1057.86  283.74 0.01
TACg (mmol/l) 919.77  28.05 979.83  30.61 60.06  40.76 915.06  26.10 984.54  26.81 69.48  38.13 0.86
GSHh (mmol/l) 763.95  36.14 783.68  45.76 19.73  53.20 700.90  38.50 1020.88  53.28 319.98  59.09 <0.001
Uric acid (mg/dL) 5.5  0.3 5.4  0.2 0.1  0.3 4.9  0.2 5.6  0.2 0.7  0.2 0.03
a
Obtained from repeated measures ANOVA.
b
HOMA-IR: Homeostasis model of assessment -insulin resistance.
c
FPG: fasting plasma glucose.
d
LDL-cholesterol: low density lipoprotein-cholesterol.
e
HDL-cholesterol: high density lipoprotein-cholesterol.
f
Hs-CRP: high sensitivity C-reactive protein.
g
TAC: total antioxidant capacity.
h
GSH: total Glutathione.
202 Z. Asemi et al. / Clinical Nutrition 33 (2014) 198e203

serum triglycerides, total- and LDL-cholesterol levels as well as Some points need to be considered in the interpretation of our
increased concentrations of HDL-cholesterol in hypercholesterol- ndings. First is limiting the duration of supplementation to 6
emic pigs after 8 weeks.8 A signicant reduction in serum total- and weeks. However, even in this short time we observed a signicant
LDL-cholesterol levels was also seen with intake of a synbiotic effect of synbiotic food on metabolic status of diabetic patients.
containing Lactobacillus gasseri and inulin among hypercholester- Long period of supplementation might lead to additional benets.
olemic patients after 12 weeks.20 Despite these, some reports have We considered hs-CRP as a surrogate marker of inammation in the
reached conicting ndings.21 Different study designs, the dosage current study. However, other inammatory markers might better
of synbiotic used and the patients under investigation as well as represent the inammation. Further studies are required to assess
duration of supplementation can explain the different ndings. The the effect of synbiotics on other inammatory biomarkers. Due to
underlying mechanisms of the modulation of serum lipid proles the use of different bacteria strains in different studies, the cross-
by synbiotics have remained largely obscure. It seems that pro- study comparisons are not easy. Additional studies must explore
biotics can affect serum lipid proles through their immune- the best composition of a synbiotic food (in terms of both bacteria
modulatory effects.22 Their inuence on TLR4 signaling and pro- strains and the appropriate prebiotic) inuencing metabolic con-
inammatory cytokines23 might also explain their lipid lowering ditions in diabetic patients.
effects. The effects on insulin sensitivity might be attributed to their In conclusion, consumption of a synbiotic food for 6 weeks
impact on gene expression that results in decreased inammatory among diabetic patients had signicant effects on serum insulin,
activity and adiposity.24 hs-CRP, uric acid and plasma total GSH levels, but could not affect
The current study showed that consumption of synbiotic food plasma TAC concentrations.
for 6 weeks among diabetic patients signicantly decreased serum
hs-CRP. In line with our ndings, the benecial effects of a synbiotic Funding
food containing Lactobacillus casei, Bidobacterium breve and
galacto-oligosaccharides on serum hs-CRP levels have been indi- The study was supported by a grant (no. 91288) from Qom
cated in patients undergoing hepatobiliary resection.25 Further- University of Medical Sciences.
more, consumption of a synbiotic food in patients with severe
multiple injuries for 7 and 15 days11 has resulted in the same Conicts of interest
nding. Similar observations have also been made after intake of
oral synbiotic containing Bidobacterium, Lactobacillus and galacto- None of the authors had any personal or nancial conict of
oligosaccharides among hepatectomized patients with or without interest.
liver cirrhosis.26 Several mechanisms can explain the benecial
effects of synbiotic food on serum hs-CRP levels. Consumption of a
Authors contributions
synbiotic food might result in signicant changes in gut micro-
biota.27 Gut fermentation of inulin increases short-chain fatty acid
ZA and AE contributed in conception, design, statistical analysis
(SCFA) production, which can in turn led to decreased expression of
and drafting of the manuscript. ZT, AK-R, S-AA and HS contributed
inammation-relevant genes including IL-6, IL-8, cyclooxygenase-
in data collection and manuscript drafting. AE supervised the study.
2, IL-1a.28 The up-regulation of IL-18 protein expression has also
All authors approved the nal version for submission.
been shown by SCFA products.29 This protein has been associated
with a reduced enzymatic synthesis of hepatic CRP. Furthermore,
Acknowledgment
increased production of methylketones family (methyl-5-hepten-
2-one, 2-propanone, 2-butanone, 2-pentanone, 2,3-butanedione)
The present study was supported by a grant (no. 91288) from
in gut following synbiotic intake27 might lead to anti-inammatory
the Vice-chancellor for Research, QUMS, Qum, Iran. We are grateful
effects.
to the Research and Development Division of Sekkeh Gaz Company,
We found that supplementation with a synbiotic food could
Isfahan, Iran that provided synbiotic product for the present study.
signicantly increase plasma total GSH and serum uric acid levels,
The authors would like to thank the staff of Golabchi Clinic (Kashan,
but did not affect plasma TAC levels. In a study by Hutt et al.,13 3-
Iran) for their assistance in this project.
weeks consumption of a synbiotic food containing Lactobacillus
fermentum ME-3, Lactobacillus paracasei and Bidobacterium lon-
gum with raftilose P95 among H. pylori-colonized asymptomatic Appendix A. Supplementary data
subjects resulted in a signicant increase in plasma TAC and
glutathione levels. Decreased levels of lipid peroxidation, increased Supplementary data related to this article can be found at http://
levels of superoxide dismutase and glutathione, along with reduced dx.doi.org/10.1016/j.clnu.2013.05.015.
levels of nitric oxide were also seen by the use of a synbiotic con-
taining L. acidophilus as a probiotic and inulin as a prebiotic in a References
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