Effect of Probiotics on Uric Acid Levels: Meta-Analysis with Subgroup Analysis and Meta-Regression

Abstract

BACKGROUND: Probiotics can modulate the microbiota and decrease uric acid levels. OBJECTIVES: This meta-analysis aimed to assess the effects of probiotics on uric acid levels. METHODS: The keywords "probiotics", "uric acid", "gout", "hyperuricemia" were searched in PubMed Medline, EMBASE, Web of Science, and Google Scholar. The search was limited to the English, French, Italian, and Spanish languages, and to the period between 1 January 2000 to 30 August 2024. We included RCTs and observational studies comparing probiotics to placebo. We excluded studies reporting (1) prebiotics, symbiotics, or postbiotics, (2) animal studies, and (3) case reports, commentaries, or reviews. Two independent reviewers performed quality assessment and data extraction. This meta-analysis was performed according to the PRISMA 2020 and AMSTAR 2 guidelines. The main outcome measure was uric acid levels "after-before" probiotic versus placebo interventions. Forest plots summarized the data using a random model. RESULTS: Nine studies included 394 patients, of whom 201 were treated with probiotics and 193 with placebo. There was a statistically significant difference in favor of the probiotic group compared with the control group regarding the main outcome measure. However, substantial heterogeneity was noted, explained (after applying subgroup analysis and meta-regression) by the following moderators: continent, diseased/healthy, male sex, and monostrain probiotics. CONCLUSIONS: This meta-analysis demonstrates that probiotics reduced uric acid levels in Asian males who had disease and were treated with monostrain probiotics.