GUT MICROBIOTA IN OBESITY AND METABOLIC SYNDROME: PATHOPHYSIOLOGY, CURRENT INSIGHTS AND THERAPEUTIC PERSPECTIVES
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5787Keywords:
Gut Microbiota, Obesity, Metabolic Syndrome, Probiotics, Fecal Microbiota Transplantation, Precision NutritionAbstract
The gut microbiota is increasingly recognized as a significant factor influencing the development of obesity and metabolic syndrome, not only through its role in digestion and nutrient metabolism, but also through its regulation of inflammation, intestinal barrier integrity, glucose and lipid metabolism, and hormonal signaling. The aim of this study was to present the current knowledge regarding the role of the gut microbiota in the pathophysiology of metabolic disorders, with particular emphasis on clinical data and the potential for therapeutic intervention on the microbiome. This study is a narrative review based on a systematic analysis of the literature. The full texts of 77 scientific publications from 2016–2026 were analyzed, of which 48 were included in the final synthesis. Studies on obesity, metabolic syndrome, dietary interventions, probiotics, prebiotics, synbiotics, fecal microbiota transplantation, and next-generation therapies were included. Available data indicate that dietary interventions, weight loss, increased fiber intake, and dietary strategies supporting microbiota diversity currently have the greatest practical significance. Probiotics, synbiotics, Akkermansia muciniphila, and fecal microbiota transplantation remain promising therapeutic approaches, but they still require further validation. The gut microbiota may in the future become a component of personalized treatment for metabolic disorders; however, its clinical application requires further research, standardization of methods, and identification of patient populations that may benefit the most.
References
Abuqwider, J. N., Mauriello, G., & Altamimi, M. (2021). Akkermansia muciniphila, a new generation of beneficial microbiota in modulating obesity: A systematic review. Microorganisms, 9(5), Article 1098. https://doi.org/10.3390/microorganisms9051098
Antwi, J. (2023). Precision nutrition to improve risk factors of obesity and type 2 diabetes. Current Nutrition Reports, 12, 679–694. https://doi.org/10.1007/s13668-023-00491-y
Asnicar, F., Berry, S. E., Valdes, A. M., Nguyen, L. H., Piccinno, G., Drew, D. A., Leeming, E., Gibson, R., Le Roy, C., Khatib, H. A., Francis, L., Mazidi, M., Mompeo, O., Valles-Colomer, M., Tett, A., Beghini, F., Dubois, L., Bazzani, D., Thomas, A. M., ... Segata, N. (2021). Microbiome connections with host metabolism and habitual diet from 1,098 deeply phenotyped individuals. Nature Medicine, 27, 321–332. https://doi.org/10.1038/s41591-020-01183-8
Bagheri, S., Soltani, S., & Aghamohammadi, V. (2022). Beneficial effects of anti-inflammatory diet in modulating gut microbiota and controlling obesity. Nutrients, 14(19), Article 3985. https://doi.org/10.3390/nu14193985
Chanda, D., & De, D. (2024). Meta-analysis reveals obesity associated gut microbial alteration patterns and reproducible contributors of functional shift. Gut Microbes, 16(1), Article 2304900. https://doi.org/10.1080/19490976.2024.2304900
Chen, M., Tang, T. C., Chen, Y. Y., & Zheng, H. (2025). A meta-analysis of changes in gut microbiota structure following bariatric surgery. International Journal of Surgery, 111(11), 8480–8492. https://doi.org/10.1097/JS9.0000000000002977
Chen, T., Wang, J., Liu, Z., & Gao, F. (2024). Effect of supplementation with probiotics or synbiotics on cardiovascular risk factors in patients with metabolic syndrome: A systematic review and meta-analysis of randomized clinical trials. Frontiers in Endocrinology, 14, Article 1282699. https://doi.org/10.3389/fendo.2023.1282699
Cuevas-Sierra, A., Milagro, F. I., Guruceaga, E., Cuervo, M., Goni, L., García-Granero, M., Martinez, J. A., & Riezu-Boj, J. I. (2022). A weight-loss model based on baseline microbiota and genetic scores for selection of dietary treatments in overweight and obese population. Clinical Nutrition, 41(8), 1712–1723. https://doi.org/10.1016/j.clnu.2022.06.008
Depommier, C., Everard, A., Druart, C., Plovier, H., Van Hul, M., Vieira-Silva, S., Falony, G., Raes, J., Maiter, D., Delzenne, N. M., de Barsy, M., Loumaye, A., Hermans, M. P., Thissen, J. P., de Vos, W. M., & Cani, P. D. (2019). Supplementation with Akkermansia muciniphila in overweight and obese human volunteers: A proof-of-concept exploratory study. Nature Medicine, 25, 1096–1103. https://doi.org/10.1038/s41591-019-0495-2
Déchelotte, P., Breton, J., Trotin-Picolo, C., Grube, B., Erlenbeck, C., Bothe, G., Fetissov, S. O., & Lambert, G. (2021). The probiotic strain H. alvei HA4597 improves weight loss in overweight subjects under moderate hypocaloric diet: A proof-of-concept, multicenter randomized, double-blind placebo-controlled study. Nutrients, 13(6), Article 1902. https://doi.org/10.3390/nu13061902
Geng, J., Ni, Q., Sun, W., Li, L., & Feng, X. (2022). The links between gut microbiota and obesity and obesity related diseases. Biomedicine & Pharmacotherapy, 147, Article 112678. https://doi.org/10.1016/j.biopha.2022.112678
Gofron, K. K., Wasilewski, A., & Małgorzewicz, S. (2025). Effects of GLP-1 analogues and agonists on the gut microbiota: A systematic review. Nutrients, 17(8), Article 1303. https://doi.org/10.3390/nu17081303
Gomes, A. C., Hoffmann, C., & Mota, J. F. (2018). The human gut microbiota: Metabolism and perspective in obesity. Gut Microbes, 9(4), 308–325. https://doi.org/10.1080/19490976.2018.1465157
Hiel, S., Gianfrancesco, M. A., Rodriguez, J., Portheault, D., Leyrolle, Q., Bindels, L. B., Gomes da Silveira Cauduro, C., Mulders, M. D. G. H., Zamariola, G., Azzi, A. S., Kalala, G., Pachikian, B. D., Amadieu, C., Neyrinck, A. M., Loumaye, A., Cani, P. D., Lanthier, N., Trefois, P., Klein, O., ... Delzenne, N. M. (2020). Link between gut microbiota and health outcomes in inulin-treated obese patients: Lessons from the Food4Gut multicenter randomized placebo-controlled trial. Clinical Nutrition, 39(12), 3618–3628. https://doi.org/10.1016/j.clnu.2020.04.005
Huey, S. L., Mehta, N. H., Steinhouse, R. S., Jin, Y., Kibbee, M., Kuriyan, R., Finkelstein, J. L., & Mehta, S. (2025). Precision nutrition-based interventions for the management of obesity in children and adolescents up to the age of 19 years. Cochrane Database of Systematic Reviews, 2025(1), Article CD015877. https://doi.org/10.1002/14651858.CD015877
Jardon, K. M., Canfora, E. E., Goossens, G. H., & Blaak, E. E. (2022). Dietary macronutrients and the gut microbiome: A precision nutrition approach to improve cardiometabolic health. Gut, 71(6), 1214–1226. https://doi.org/10.1136/gutjnl-2020-323715
Jian, H., Liu, Y., Wang, X., Dong, X., & Zou, X. (2023). Akkermansia muciniphila as a next-generation probiotic in modulating human metabolic homeostasis and disease progression: A role mediated by gut–liver–brain axes? International Journal of Molecular Sciences, 24(4), Article 3900. https://doi.org/10.3390/ijms24043900
Johnson, A. J., O'Sullivan, E. N., Valyasevi, P., Metras, B., Jang, S., Shields-Cutler, R., Hendel, K. R., Harindhanavudhi, T., & Teigen, L. (2026). The potential for complex interplay between GLP-1 receptor agonists, gut microbiome, and obesity management. Canadian Journal of Physiology and Pharmacology, 104, 1–8. https://doi.org/10.1139/cjpp-2025-0219
Kootte, R. S., Levin, E., Salojärvi, J., Smits, L. P., Hartstra, A. V., Udayappan, S. D., Hermes, G., Bouter, K. E., Koopen, A. M., Holst, J. J., Knop, F. K., Blaak, E. E., Zhao, J., Smidt, H., Harms, A. C., Hankemeijer, T., Bergman, J. J. G. H. M., Romijn, H. A., Schaap, F. G., ... Nieuwdorp, M. (2017). Improvement of insulin sensitivity after lean donor feces in metabolic syndrome is driven by baseline intestinal microbiota composition. Cell Metabolism, 26(4), 611–619.e6. https://doi.org/10.1016/j.cmet.2017.09.008
Koutoukidis, D. A., Jebb, S. A., Zimmerman, M., Otunla, A., Henry, J. A., Ferrey, A., Schofield, E., Kinton, J., Aveyard, P., & Marchesi, J. R. (2022). The association of weight loss with changes in the gut microbiota diversity, composition, and intestinal permeability: A systematic review and meta-analysis. Gut Microbes, 14(1), Article 2020068. https://doi.org/10.1080/19490976.2021.2020068
Lahtinen, P., Juuti, A., Luostarinen, M., Niskanen, L., Liukkonen, T., Tillonen, J., Kössi, J., Ilvesmäki, V., Viljakka, M., Satokari, R., & Arkkila, P. (2022). Effectiveness of fecal microbiota transplantation for weight loss in patients with obesity undergoing bariatric surgery: A randomized clinical trial. JAMA Network Open, 5(12), Article e2247226. https://doi.org/10.1001/jamanetworkopen.2022.47226
Liu, B. N., Liu, X. T., Liang, Z. H., & Wang, J. H. (2021). Gut microbiota in obesity. World Journal of Gastroenterology, 27(25), 3837–3850. https://doi.org/10.3748/wjg.v27.i25.3837
Memon, H., Abdulla, F., Reljic, T., Alnuaimi, S., Serdarevic, F., Asimi, Z. V., Kumar, A., & Semiz, S. (2023). Effects of combined treatment of probiotics and metformin in management of type 2 diabetes: A systematic review and meta-analysis. Diabetes Research and Clinical Practice, 202, Article 110806. https://doi.org/10.1016/j.diabres.2023.110806
Michael, D. R., Jack, A. A., Masetti, G., Davies, T. S., Loxley, K. E., Kerry-Smith, J., Plummer, J. F., Marchesi, J. R., Mullish, B. H., McDonald, J. A. K., Hughes, T. R., Wang, D., Garaiova, I., Paduchová, Z., Muchová, J., Good, M. A., & Plummer, S. F. (2020). A randomised controlled study shows supplementation of overweight and obese adults with lactobacilli and bifidobacteria reduces bodyweight and improves well-being. Scientific Reports, 10, Article 4183. https://doi.org/10.1038/s41598-020-60991-7
Mocanu, V., Zhang, Z., Deehan, E. C., Kao, D. H., Hotte, N., Karmali, S., Birch, D. W., Samarasinghe, K. K., Walter, J., & Madsen, K. L. (2021). Fecal microbial transplantation and fiber supplementation in patients with severe obesity and metabolic syndrome: A randomized double-blind, placebo-controlled phase 2 trial. Nature Medicine, 27, 1272–1279. https://doi.org/10.1038/s41591-021-01399-2
Mohr, A. E., Sweazea, K. L., Bowes, D. A., Jasbi, P., Whisner, C. M., Sears, D. D., Krajmalnik-Brown, R., Jin, Y., Gu, H., Klein-Seetharaman, J., Arciero, K. M., Gumpricht, E., & Arciero, P. J. (2024). Gut microbiome remodeling and metabolomic profile improves in response to protein pacing with intermittent fasting versus continuous caloric restriction. Nature Communications, 15, Article 4155. https://doi.org/10.1038/s41467-024-48355-5
Mueller, N. T., Differding, M. K., Zhang, M., Maruthur, N. M., Juraschek, S. P., Miller, E. R., Appel, L. J., & Yeh, H.-C. (2021). Metformin affects gut microbiome composition and function and circulating short-chain fatty acids: A randomized trial. Diabetes Care, 44(7), 1462–1471. https://doi.org/10.2337/dc20-2257
Niu, X., Zhang, Q., Liu, J., Zhao, Y., Shang, N., Li, S., Liu, Y., Xiong, W., Sun, E., Zhang, Y., Zhao, H., Li, Y., Wang, P., Fang, B., Zhao, L., Chen, J., Wang, F., Pang, G., Wang, C., ... Wang, R. (2024). Effect of synbiotic supplementation on obesity and gut microbiota in obese adults: A double-blind randomized controlled trial. Frontiers in Nutrition, 11, Article 1510318. https://doi.org/10.3389/fnut.2024.1510318
Ojo, O., Feng, Q. Q., Ojo, O. O., & Wang, X. H. (2020). The role of dietary fibre in modulating gut microbiota dysbiosis in patients with type 2 diabetes: A systematic review and meta-analysis of randomised controlled trials. Nutrients, 12(11), Article 3239. https://doi.org/10.3390/nu12113239
Ojo, O., Ojo, O. O., Zand, N., & Wang, X. (2021). The effect of dietary fibre on gut microbiota, lipid profile, and inflammatory markers in patients with type 2 diabetes: A systematic review and meta-analysis of randomised controlled trials. Nutrients, 13(6), Article 1805. https://doi.org/10.3390/nu13061805
Perler, B. K., Friedman, E. S., & Wu, G. D. (2023). The role of the gut microbiota in the relationship between diet and human health. Annual Review of Physiology, 85, 449–468. https://doi.org/10.1146/annurev-physiol-031522-092054
Pinart, M., Dötsch, A., Schlicht, K., Laudes, M., Bouwman, J., Forslund, S. K., Pischon, T., & Nimptsch, K. (2022). Gut microbiome composition in obese and non-obese persons: A systematic review and meta-analysis. Nutrients, 14(1), Article 12. https://doi.org/10.3390/nu14010012
Puljiz, Z., Kumric, M., Vcev, A., & Bozic, J. (2023). Obesity, gut microbiota, and metabolome: From pathophysiology to nutritional interventions. Nutrients, 15(10), Article 2236. https://doi.org/10.3390/nu15102236
Qiu, B., Liang, J., & Li, C. (2023). Effects of fecal microbiota transplantation in metabolic syndrome: A meta-analysis of randomized controlled trials. PLOS ONE, 18(7), Article e0288718. https://doi.org/10.1371/journal.pone.0288718
Rein, M., Ben-Yacov, O., Godneva, A., Shilo, S., Zmora, N., Kolobkov, D., Cohen-Dolev, N., Wolf, B. C., Kosower, N., Lotan-Pompan, M., Weinberger, A., Halpern, Z., Zelber-Sagi, S., Elinav, E., & Segal, E. (2022). Effects of personalized diets by prediction of glycemic responses on glycemic control and metabolic health in newly diagnosed T2DM: A randomized dietary intervention pilot trial. BMC Medicine, 20, Article 56. https://doi.org/10.1186/s12916-022-02254-y
Roager, H. M., Vogt, J. K., Kristensen, M., Hansen, L. B. S., Ibrügger, S., Mærkedahl, R. B., Bahl, M. I., Lind, M. V., Nielsen, R. L., Frøkiær, H., Gøbel, R. J., Landberg, R., Ross, A. B., Brix, S., Holck, J., Meyer, A. S., Sparholt, M. H., Christensen, A. F., Carvalho, V., ... Licht, T. R. (2019). Whole grain-rich diet reduces body weight and systemic low-grade inflammation without inducing major changes of the gut microbiome. Gut, 68(1), 83–93. https://doi.org/10.1136/gutjnl-2017-314786
Saad, M. J. A., Santos, A., & Prada, P. O. (2016). Linking gut microbiota and inflammation to obesity and insulin resistance. Physiology, 31(4), 283–293. https://doi.org/10.1152/physiol.00041.2015
Stanislawski, M. A., Dabelea, D., Lange, L. A., Wagner, B. D., & Lozupone, C. A. (2019). Gut microbiota phenotypes of obesity. npj Biofilms and Microbiomes, 5, Article 18. https://doi.org/10.1038/s41522-019-0091-8
Stenman, L. K., Lehtinen, M. J., Meland, N., Christensen, J. E., Yeung, N., Saarinen, M. T., Courtney, M., Burcelin, R., Lähdeaho, M.-L., Linros, J., Apter, D., Scheinin, M., Smerud, H. K., Rissanen, A., & Lahtinen, S. (2016). Probiotic with or without fiber controls body fat mass, associated with serum zonulin, in overweight and obese adults: Randomized controlled trial. EBioMedicine, 13, 190–200. https://doi.org/10.1016/j.ebiom.2016.10.036
Toderescu, C. D., Parveen, M., Trifunschi, S., Oancea, A., Ciubuc, G. C., Cresneac, I. G., Munteanu, M. F., Ciopanoiu, I., Boru, C., Pogurschi, E. N., Ionite, C., Stefanache, A., & Lungu, I. I. (2026). Dietary polyphenols as modulators of Bifidobacterium in the human gut microbiota. Nutrients, 18(7), Article 782. https://doi.org/10.3390/nu18070782
Wang, S., Bao, Z., Li, Z., Zhao, M., Wang, X., & Liu, F. (2025). The impact of very-low-calorie ketogenic diets on gut microbiota in individuals with obesity: A systematic review and meta-analysis. Gut Microbes, 17(1), Article 2566305. https://doi.org/10.1080/19490976.2025.2566305
Wastyk, H. C., Fragiadakis, G. K., Perelman, D., Dahan, D., Merrill, B. D., Yu, F. B., Topf, M., Gonzalez, C. G., Van Treuren, W., Han, S., Robinson, J. L., Elias, J. E., Sonnenburg, E. D., Gardner, C. D., & Sonnenburg, J. L. (2021). Gut-microbiota-targeted diets modulate human immune status. Cell, 184(16), 4137–4153.e14. https://doi.org/10.1016/j.cell.2021.06.019
Yoo, S., Jung, S. C., Kwak, K., & Kim, J. S. (2024). The role of prebiotics in modulating gut microbiota: Implications for human health. International Journal of Molecular Sciences, 25(9), Article 4834. https://doi.org/10.3390/ijms25094834
Zecheng, L., Donghai, L., Runchuan, G., Yuan, Q., Qi, J., Yijia, Z., Shuaman, R., Xiaoqi, L., Yi, W., Ni, M., Yijin, Q., Liang, P., & Jun, W. (2023). Fecal microbiota transplantation in obesity metabolism: A meta-analysis and systematic review. Diabetes Research and Clinical Practice, 202, Article 110803. https://doi.org/10.1016/j.diabres.2023.110803
Zhang, C., Zhang, Q., Zhang, X., Du, S., Zhang, Y., Wang, X., Liu, Y., Fang, B., Chen, J., Liu, R., Hao, Y., & Zhao, L. (2025). Effects of synbiotics surpass probiotics alone in improving type 2 diabetes mellitus: A randomized, double-blind, placebo-controlled trial. Clinical Nutrition, 44, 248–258. https://doi.org/10.1016/j.clnu.2024.11.042
Zhang, S., Wu, P., Tian, Y., Liu, B., Huang, L., Liu, Z., Lin, N., Xu, N., Ruan, Y., Zhang, Z., Wang, M., Cui, Z., Zhou, H., Xie, L., Chen, H., & Sun, J. (2021). Gut microbiota serves a predictable outcome of short-term low-carbohydrate diet intervention for patients with obesity. Microbiology Spectrum, 9, Article e0022321. https://doi.org/10.1128/Spectrum.00223-21
Zhang, Y., Liu, R., Chen, Y., Cao, Z., Liu, C., Bao, R., Wang, Y., Huang, S., Pan, S., Qin, L., Wang, J., Ning, G., & Wang, W. (2025). Akkermansia muciniphila supplementation in patients with overweight/obese type 2 diabetes: Efficacy depends on its baseline levels in the gut. Cell Metabolism, 37(3), 592–605. https://doi.org/10.1016/j.cmet.2024.12.010
Zhou, X., Zheng, W., Kong, W., Zhang, J., Liao, Y., Min, J., & Zeng, T. (2025). Glucose parameters, inflammation markers, and gut microbiota changes of gut microbiome-targeted therapies in type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials. The Journal of Clinical Endocrinology & Metabolism, 110(10), 2980–3008. https://doi.org/10.1210/clinem/dgaf340
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Agata Kowalczyk, Magdalena Fąfara, Margartia Jeczkało, Monika Kosiorowska, Joanna Lasoń, Marcelina Makulska, Weronika Płachta, Wiktoria Sęk, Amelia Sieradzka, Cezary Wegenko
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
How to Cite
