Obesity and metabolic syndrome are important health problems that can lead to significant morbidity/mortality as well as subsequent health concerns. Alterations in the gut microbiota have been implicated in both obesity and metabolic syndrome. Fecal Microbiota Transplantation (FMT) has emerged as a new promising therapeutic approach aimed at manipulating the gut microbiota in various chronic diseases. Randomized clinical trials assessing the use of FMT in obese and metabolic syndrome patients have been reported. The purpose of this systematic review with meta-analysis using randomized clinical trials (RCT) is to evaluate the role of FMT for the treatment of obesity and metabolic syndrome and its impact on clinically relevant parameters. We searched the main databases, as well as the gray literature, to identify RCTs comparing FMT from lean donor(s) vs placebo for obese/metabolic syndrome patients. We included all studies that utilized any form of placebo (sham, saline, autologous FMT, or placebo capsules). Six studies met the inclusion criteria and were included for final analysis with a total of 154 patients. We looked for clinically significant parameters related to obesity and metabolic syndrome and organized the findings into early (2-6 weeks after intervention) and late (12 weeks after intervention) outcomes. Two to 6 weeks after intervention, mean HbA1c was lower in the FMT group (MD = -1.69 mmol/L, CI [-2.88, -0.56], P = .003) and mean HDL cholesterol was higher in the FMT group (MD = 0.09 mmol/L, CI [0.02, 0.15], P = .008). There was no difference in obesity parameters 6 to 12 weeks after intervention. No serious adverse events were reported. The findings for this meta-analysis show that FMT may have a role for the treatment of metabolic syndrome, but there is currently not enough evidence to support its use in clinical practice. High-quality well-powered RCTS with longer follow-up are necessary to clarify the role of FMT in this patient cohort.

中文翻译：

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粪便微生物群移植改善代谢综合征参数：基于随机临床试验的荟萃分析系统评价

肥胖和代谢综合征是重要的健康问题，可导致显着的发病率/死亡率以及随后的健康问题。肠道微生物群的改变与肥胖和代谢综合征有关。粪便微生物群移植（FMT）已成为一种新的有前途的治疗方法，旨在操纵各种慢性疾病中的肠道微生物群。已经报道了评估 FMT 在肥胖和代谢综合征患者中使用的随机临床试验。本系统评价和荟萃分析使用随机临床试验 (RCT) 的目的是评估 FMT 在治疗肥胖和代谢综合征中的作用及其对临床相关参数的影响。我们搜索了主要数据库以及灰色文献，确定比较瘦供体与安慰剂对肥胖/代谢综合征患者的 FMT 的随机对照试验。我们纳入了所有使用任何形式的安慰剂（假药、生理盐水、自体 FMT 或安慰剂胶囊）的研究。6 项研究符合纳入标准，共纳入 154 名患者进行最终分析。我们寻找与肥胖和代谢综合征相关的临床重要参数，并将结果分为早期（干预后 2-6 周）和晚期（干预后 12 周）结果。干预后 2 至 6 周，FMT 组的平均 HbA1c 较低（MD = -1.69 mmol/L，CI [-2.88，-0.56]，P = .003），FMT 组的平均 HDL 胆固醇较高（MD = 0.09 mmol/L, CI [0.02, 0.15], P = .008)。干预后 6 至 12 周的肥胖参数没有差异。没有报告严重的不良事件。这项荟萃分析的结果表明 FMT 可能在治疗代谢综合征方面发挥作用，但目前没有足够的证据支持其在临床实践中的应用。需要具有更长随访时间的高质量、强有力的 RCTS 来阐明 FMT 在该患者队列中的作用。