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oai:figshare.com:article/34038168 2026-10-01T04:31:55Z category_374 portal_316 item_type_3 month_year_10_2026

Supplementary file 1_Probiotics and synbiotics as adjunctive therapies for heart failure: a systematic review with network and pairwise meta-analyses.docx Qin Liu (59805) Huanxin Xie (3827578) Fenwang Lin (15340151) Wenrui Huang (8088398) Jinxiong Lao (25151787) Clinical and Sports Nutrition gut microbiota heart failure network meta-analysis pairwise meta-analysis probiotics randomized controlled trial synbiotics Objective<p>This study aimed to evaluate the use of probiotics and synbiotics as microbiome-directed adjunctive therapies for heart failure (HF), while explicitly determining whether any eligible prebiotic-only trials existed.</p>Methods<p>We searched eight English- and Chinese-language databases from inception to 1 May 2026 and conducted expanded sensitivity searches in PubMed, Embase, and Web of Science on 15 July 2026. Random-effects network meta-analysis (NMA) was used only for connected multi-node evidence; two-node evidence was analyzed pairwise. As placebo, usual care, and food comparators were not clinically exchangeable, comparator-stratified sensitivity analyses of direct evidence were conducted using restricted maximum likelihood (REML) and Hartung-Knapp (HK) confidence intervals (CIs).</p>Results<p>A total of 12 randomized studies were included in the systematic review (14 reports); 11 contributed to at least one primary or sensitivity quantitative analysis, and 10 contributed to the primary analyses. The revision-stage search audit identified no additional eligible randomized trials and no eligible prebiotic-only trials. Across all the trial populations, 1,021 participants were randomized, 973 of whom were allocated to review-eligible arms. The left ventricular ejection fraction (LVEF) network included 7 studies and 539 participants in the analysis set; however, this network was star-shaped, had no closed loops, and depended on a combined comparator node. The exploratory NMA estimate for multi-strain bacterial probiotics versus the combined comparator was a mean difference (MD) of 2.13 percentage points (95% confidence interval [CI] −0.10 to 4.35). The comparator-stratified sensitivity analysis for usual care yielded an MD of 1.83 percentage points (95% CI −2.33 to 5.98). All synthesized results were assessed as having either some concern or a high risk of bias. The effect estimates were generally imprecise, and the certainty of evidence was low or very low. Adverse event definitions and denominators were inconsistent.</p>Conclusion<p>The available evidence is sparse and affected by significant non-transitivity, risk of bias, and imprecision. Network comparisons and rankings should be considered hypothesis-generating; therefore, no probiotic or synbiotic adjunct can be recommended for routine HF management.</p>Systematic review registration<p>CRD420261413595. Public URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261413595.</p> 2026-10-01T04:31:55Z Dataset Dataset 10.3389/fnut.2026.1898538.s001 https://figshare.com/articles/dataset/Supplementary_file_1_Probiotics_and_synbiotics_as_adjunctive_therapies_for_heart_failure_a_systematic_review_with_network_and_pairwise_meta-analyses_docx/34038168 CC BY 4.0