Effects of native Lactobacillus rhamnosus, Lactobacillus fermentum, and Lactobacillus plantarum on serum level of omentin-1, glycemic markers, and lipid profile in obese adults: A triple-blind clinical trial

Effects of native Lactobacillus rhamnosus, Lactobacillus fermentum, and Lactobacillus plantarum on serum level of omentin-1, glycemic markers, and lipid profile in obese adults: A triple-blind clinical trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Effects of native Lactobacillus rhamnosus, Lactobacillus fermentum, and Lactobacillus plantarum on serum level of omentin-1, glycemic markers, and lipid profile in obese adults: A triple-blind clinical trial Vahideh Ebrahimzadeh, Faezeh Amani, Jamileh Ghalami, Leila Roozbeh-Nasiraie, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7956544/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background: Obesity is a multifactorial disorder strongly associated with metabolic dysfunction and chronic inflammation. Emerging evidence suggests that modulation of the gut microbiota through probiotic supplementation may improve metabolic outcomes. This study investigated the effects of three native Lactobacillus strains on serum omentin-1 levels, glycemic indices, and lipid profiles in obese adults. Methods: In this 8-week, triple-blind, randomized, placebo-controlled clinical trial, 100 obese adults (BMI 30–40 kg/m²) were assigned to four groups receiving daily sachets containing Lactobacillus fermentum NIMBB014, Lactobacillus rhamnosus NIMBB006, Lactobacillus plantarum (2 × 10⁹ CFU), or placebo. Serum omentin-1, anthropometric, glycemic (FBS, HbA1c, insulin, HOMA-IR, QUICKI, serum α-amylase), and lipid (TC, TG, HDL, LDL, VLDL) parameters were assessed at baseline and after 8 weeks. Data were analyzed using the paired t-tests and ANCOVA, adjusting for age, sex, baseline values, and BMI. Results: After 8 weeks, no significant between-group differences were observed in omentin-1 or glycemic indices. However, within-group analyses indicated significant reductions in insulin and QUICKI in both the L. fermentum and L. plantarum groups (P < 0.05). L. plantarum supplementation resulted in a significant decrease in total cholesterol (P = 0.008) and an increase in HDL (P = 0.046) compared with placebo, along with significant within-group reductions in TG and VLDL (P < 0.05). No adverse effects were reported. Conclusion: These findings suggest strain-specific probiotic benefits in obesity management, warranting longer interventions and larger trials to confirm metabolic effects. Health sciences/Diseases Health sciences/Diseases/Nutrition disorders/Obesity Probiotics Lactobacillus Omentin-1 Obesity Lipid profile Glycemic control Figures Figure 1 Figure 2 1. Introduction Overweight and obesity represent escalating global health challenges, as their prevalence is increasing considerably around the world [ 1 , 2 ]. As reported by the World Health Organization (WHO), more than 1.9 billion adults are overweight, and around 650 million are suffering from obesity. It is also estimated that by 2030, one billion people worldwide will be living with obesity, which amounts to roughly 1 in 5 women and 1 in 7 men [ 3 , 4 ]. The etiology of overweight and obesity is multifactorial, involving an interplay between genetic predisposition, epigenetic modifications, neuroendocrine regulation, energy-dense diets, physical inactivity, and broader environmental and socioeconomic determinants [ 5 ]. These conditions are strongly associated with an elevated risk of cardiometabolic disorders—including type 2 diabetes mellitus, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease—as well as certain malignancies and degenerative joint diseases. Moreover, obesity is increasingly recognized as a state of chronic low-grade inflammation, contributing to systemic metabolic dysregulation [ 5 , 6 ]. Omentin is a recently identified adipokine predominantly expressed in visceral adipose tissue. Among its two known isoforms, omentin-1 is the primary circulating form and is considered to exert insulin-sensitizing, anti-inflammatory, and anti-atherogenic effects. Emerging evidence suggests that circulating levels of omentin are inversely associated with anthropometric indices in obesity, and it has been associated with hallmarks of obesity-related metabolic dysfunction [ 7 – 10 ]. Besides the low-calorie diets and lifestyle modifications, the current repertoire of safe and effective treatments for obesity remains limited, and there is a need for new approaches to reduce the significant impact of obesity on health [ 11 ]. Recent studies have shown that dysbiosis, an imbalance in the gut microbiome, is linked to the onset of obesity [ 12 ]. Therefore, probiotics may have positive impacts on obesity and associated metabolic issues, including insulin resistance, hypertension, irregular lipid levels, and enhanced immune defense [ 13 ]. A variety of studies suggest that probiotics may help control and prevent obesity by enhancing microbial diversity, promoting the production of short-chain fatty acids, and regulating appetite [ 14 ]. Results of recent systematic reviews and meta-analyses also show some promising results of probiotics, including improvements in the Glycemic index [ 12 , 15 ] and a significant reduction in the lipid profile [ 16 – 18 ]. However, the results of studies on different probiotic genera are, to some extent, contradictory. For example, some studies have revealed the beneficial effects of probiotics and prebiotics on lipid profiles [ 19 – 22 ], glycemic markers [ 23 – 25 ], and omentin-1 [ 26 , 27 ]. In contrast, some others have not achieved the same effect [ 28 , 29 ]. Therefore, the present study aimed to investigate the effects of three different native Iranian strains, including Lactobacillus rhamnosus, Lactobacillus fermentum, and Lactobacillus plantarum , on the serum level of omentin-1, glycemic markers, and lipid profile in obese subjects. 2. Methods and materials 2.1 Study design and subjects One hundred eligible, healthy, obese subjects participated in this 8-week, triple-blind, placebo-controlled, randomized clinical trial. The sample size was calculated based on the change in waist circumference (WC) levels, one of our primary variables, as reported in the study conducted by Zarati et al. [ 26 ], with α = 0.05 and a power of 90%, resulting in 22 participants per group. By considering a 15% dropout, 25 individuals were assigned to each group. Participants were recruited through a general call schedule across the city of Karaj, Iran. The inclusion criteria were both sexes, aged 18–60 years, with a body mass index (BMI) of 30–40 kg/m². Exclusion criteria were pregnant or breastfeeding women, smokers, regular consumers of nutritional supplements and probiotics, consumers of corticosteroids, gastric surgery, thyroid problems, a history of diabetes and kidney disease, weight loss within the last 3 months, and intense physical activity. The study was accepted by the Ethical Committee of Alborz University of Medical Sciences (IR.ABZUMS.REC.1401.054) and Tabriz University of Medical Sciences ( IR.TBZMED.REC.1403.362). It was also registered in the Iranian Registry of Clinical Trials (IRCT20220608055106N1). All participants read and signed an informed consent form before study enrollment. 2.2 Randomization and Intervention Participants were randomly assigned to four groups (25 participants in each group) using a block randomization procedure. The members, the leading researcher, and the statistical advisor were blind until the end of the study. All groups consumed one sachet of probiotics (Shams Bavaran Salamat Nour Company, Tehran, Iran) mixed with water before meals for 60 days. The first group took probiotic supplements in the form of powder sachets containing native Lactobacillus fermentum NIMBB014 (2 × 10^9 CFU), isolated from the Komeh product (registration code: NCBI MT994667). The second group took powder supplements containing native Lactobacillus rhamnosus NIMBB006 (2 × 10^9 CFU), isolated from the mother’s milk (registration code: NCBI MT995144). The third group took supplements containing Lactobacillus plantarum (2 × 10^9 CFU), isolated from camel milk (registration code: 012188, NCBI MT). The fourth group received a placebo consisting of 100% maltodextrin without flavor, in a 1-gram sachet, for 60 days. 2.3 Assessments Blood samples were collected after a 10-to 12-hour overnight fast at baseline and at the end of the study. Serum samples were divided by centrifugation and stored at − 80°C until analysis. The serum level of omentin-1 was measured using the human ELISA kit (Zellbio GmbH, Ulm, Germany). The levels of Serum LDL, HDL, TC, TG, VLDL, FBC, HbA1c, and α-amylase were measured by the enzymatic colorimetric methods on an automatic analyzer (Abbott, model Alcyon 300, USA). Serum insulin concentrations were quantified utilizing a human-specific ELISA kit (Monobind Inc., Lake Forest, CA, USA). Insulin resistance index was estimated by the homeostasis model assessment of insulin resistance (HOMA-IR) calculated using the formula: [fasting serum insulin (µU/ml) × fasting serum glucose (mg/dl)/405] (50). Additionally, insulin sensitivity was assessed using the quantitative insulin sensitivity check index (QUICKI), calculated according to the following formula: [1/log insulin (µU/mL) + log glucose (mg/dL)] (50). Weight and height were also measured using a standard scale (Seca, Hamburg, Germany), with participants wearing only slight clothing and no shoes. Body mass index (BMI) was calculated by dividing weight (in kilograms) by the square of height (in meters). Dietary intake was evaluated using a validated 168-item food frequency questionnaire (FFQ). The nutrient composition and dietary data were subsequently analyzed using the Nutritionist IV software “Nutritionist 4” (First Databank Inc., Hearst Corp., and San Bruno, CA, USA). 2.4 Statistical analysis Statistical analyses were conducted using SPSS software, version 23.0 (IBM Corp., Armonk, NY, USA). The normality of data distribution was evaluated using the Kolmogorov–Smirnov test, alongside assessments of mean and SD. Possible differences at baseline among treatment groups were assessed by the one-way ANOVA test for normally distributed parameters. At the end of the study, analysis of covariance (ANCOVA) was conducted for parameters exhibiting normal distribution, incorporating baseline values, BMI, age, sex, and caloric intake as covariates. Furthermore, within-group differences in biochemical parameters were evaluated using the paired-sample t-test for normally distributed data and the Wilcoxon signed-rank test for non-parametric data. Percent changes between groups were computed using the formula outlined: (Mean intervention – Mean placebo ) ÷ Mean placebo ×100. Also, the percent change within groups was calculated using the following formula: (Mean after -Mean before ) ÷ Mean before ×100. P < 0.05 was considered indicative of statistical significance. 3. Result As illustrated in Fig. 1 , a total of 100 eligible volunteers were enrolled in the study, with each of the four groups comprising 25 participants (17 women and 8 men). However, 11 individuals did not complete the intervention. In the Lactobacillus plantarum group, two participants withdrew—one female due to pregnancy and one male due to travel commitments. In the Lactobacillus fermentum group, one male participant was excluded for failing to adhere to supplement intake. Within the placebo group, five women discontinued participation: two due to non-compliance with supplement consumption, one following a diagnosis of hypothyroidism, and two due to the use of anti-obesity medications. In the Lactobacillus rhamnosus group, three participants dropped out—two (one male and one female) due to travel, and one female following a diagnosis of hypothyroidism. Importantly, no participant discontinued the study as a result of adverse effects related to either the probiotic interventions or the placebo. Baseline characteristics of the study population are presented in Table 1 . Table 1 Baseline data of the Study Subjects in the four study groups. variables Lactobacillus plantarum (A) (n = 23) Lactobacillus fermentum (B) (n = 24) Lactobacillus rhamnosus (D) (n = 22) Placebo group(C) (n = 20) P value Sex (%) 0.742 ** Male 7 (24.1%) 7(24.1%) 7 (24.1%) 8 (27.6%) Female 16(26.7%) 17(28.3%) 15(25%) 12 (20%) Age(y) * 40.04 ± 12.12 45.75 ± 10.40 46.59 ± 9.35 44.90 \(\:\:\pm\:\) 12.42 0.197 † Education level illeterate 0 (0%) 0 (0%) 0 (0%) 1 (100%) Under diploma 4 (17.4%) 13 (56.5%) 3 (13%) 3 (13%) 0.286 # diploma 9 (30%) 6 (20%) 8 (26.7%) 7 (23.3%) university 10 (28.6%) 5 (14.3%) 11 (31.4%) 9 (25.7%) Marital status Single 3 (30%) 2 ( 20%) 2 (20%) 3 (30%) 0.857 # Married 20 (25.3%) 22 (27.8%) 20 (25.3%) 17 (21.5%) Hight * 1.64 ± 0.095 1.66 ± 0.076 1.69 ± 0.079 1.64 ± 0.10 0.278 † Weight(kg) * 90.23 ± 11.21 91.50 ± 11.13 92.74 ± 11.74 87.52 ± 10.96 0.486 † BMI(Kg/m 2 ) * 33.21 ± 3.64 32.84 ± 3.02 32.24 ± 3.24 32.33 ± 4.13 0.777 † *values ​​are reported as mean ± SD ** based on the Chi-Square test † based on one-way ANOVA test #based on Kruskal-Wallis H test The results of the comparative analysis of omentin-1 in the four groups are shown in Table 2 . There was a statistically significant difference in serum levels of omentin-1 among the groups at baseline. However, at the end of the study, after adjusting for confounding variables (age, sex, baseline values, and BMI), there were no statistically significant differences in omentin-1 levels among groups. Assessment of within-group changes did not show any statistically significant increase in omentin-1 levels in any of the groups. However, the change in omentin-1 in the Lactobacillus rhamnosus group was clinically substantial (percent changes:3.57% ). Table 2 Comparison of levels of omentin-1, glycemic markers, and lipid profile parameter values ​​in the four study groups before and after the intervention variable Lactobacillus plantarum(A) (n = 23) Lactobacillus fermentum(B) (n = 24) Lactobacillus rhamnosus(D) (n = 22) Placebo group(C) (n = 20) P Omentin-1 Baseline 9.34 ± 1.48 7.36 ± 1.01 7.83 ± 2.07 7.488 ± 1.38 0.014 a After 8 weeks 7.42 ± 0.90 6.87 ± 1.52 8.11 ± 0.930 6.98 ± 1.73 0.214 b P c 0.000 0.422 0.599 0.470 FBS Baseline 96.04 ± 6.48 97.29 ± 8.54 98.55 ± 8.075 99.90 ± 10.47 0.482 a After 8 weeks 97.26 ± 7.70 96.25 ± 7.75 97.18 ± 8.033 97.85 ± 8.83 0.339 b P c 0.348 0.276 0.283 0.118 HbA1C Baseline 5.49 ± 0.47 5.60 ± 0.44 5.586 ± 0.357 5.45 ± 0.38 0.582 a After 8 weeks 5.40 ± 0.36 5.52 ± 0.44 5.605 ± 0.283 5.50 ± 0.41 0.520 b P c 0.183 0.148 0.687 0.510 E AG Baseline 109.78 ± 12.717 113.42 ± 10.59 113.82 ± 10.38 108.60 ± 9.768 0.305 a After 8 weeks 106.04 ± 10.173 111.46 ± 10.65 114.23 ± 8.280 110 ± 11.761 0.179 b P c 0.031 0.188 0.757 0.521 HOM-IR Baseline 2.29 ± 1.02 2.617 ± 1.107 2.691 ± 1.099 2.39 ± 0.63 0.511 a After 8 weeks 2.45± 0.77 2.356 ± 0.615 2.530 ± 0.637 2.27 ± 0.64 0.535 b P c 0.503 0.198 0.449 0.498 Quicki Baseline 0.34 ± 0.030 0.348 ± 0.036 0.338 ± 0.0375 0.331 ± 0.031 0.278 a After 8 weeks 0.33 ± 0.018 0.329 ± 0.0237 0.329 ± 0.0120 0.333 ± 0.016 0.602 b P c 0.014 0.005 0.307 0.777 Insulin Baseline 8.44 ± 4.18 9.695 ± 5.73 9.924 ± 4.918 9.46 ± 3.11 0.728 a After 8 weeks 11.64 ± 3.95 13.302 ± 6.54 11.665 ± 3.030 11.14 ± 3.97 0.417 b P c 0.015 0.009 0.225 0.122 Amylase Baseline 59.37 ± 17.94 49.58 ± 12.96 58.05 ± 15.521 51.27 ± 11.89 0.322 a After 8 weeks 58.34 ± 16.41 52.35 ± 12.19 60.57 ± 17.352 54.57 ± 16.13 0.769 b P c 0.545 0.147 0.212 0.377 TC Baseline 175.04 ± 26.453 177.58 ± 33.04 181.45 ± 28.80 165.50 ± 29.747 0.357 a After 8 weeks 159.43 ± 26.483 e 182.08 ± 36.23 fa 185.86 ± 38.47 ha 171.75 ± 35.22 ga 0.008 b P c 0.006 0.395 0.456 0.070 LDL Baseline 96.43 ± 21.99 95.75 ± 31.57 102 ± 27.03 91 ± 24.29 0.614 a After 8 weeks 90.91 ± 29.01 101.63 ± 29.72 95.86 ± 33.47 98 ± 28.27 0.20 b P c 0.231 0.232 0.380 0.041 HDL Baseline 44.52 ± 6.56 51.42 ± 8.15 41.23 ± 7.78 44.55 ± 8.29 0.000 a After 8 weeks 43.22 ± 7.82 e 52.08 ± 8.91 f 40.64 ± 6.39 ef 45.60 ± 9.13 ef 0.046 b P c 0.174 0.508 0.575 0.364 VLDL Baseline 29.91 ± 11.63 26.38 ± 10.81 33.05 ± 15.71 29.30 ± 11.49 0.357 a After 8 weeks 25.83 ± 10.97 24.96 ± 8.58 33.18 ± 13.69 26.20 ± 9.23 0.153 b P c 0.030 0.384 0.954 0.047 TG Baseline 145.39 ± 49.92 132.75 ± 45.53 169.41 ± 63.47 147.20 ± 56.29 0.151 a After 8 weeks 126.52 ± 48.41 124.25 ± 43.02 167.95 ± 61.55 131.30 ± 46.14 0.176 b P c 0.032 0.290 0.846 0.042 All values are reported as mean ± SD a One-way ANOVA test b analysis of covariance (ANCOVA) adjusting for age, sex, baseline values, and BMI c Paired samples t-test The results of glycemic parameters across the four study groups are shown in Table 2 . There were no statistically significant differences in serum levels of FBS, A1C, Insulin, QUICKI, HOM-IR, EAG, and α-Amylase among the groups at baseline and also after the end of 8 weeks of intervention. Furthermore, within-group analyses showed that QUICKI and Insulin levels in the Lactobacillus fermentum (P = 0.005 and P = 0.009) and Lactobacillus plantarum (P = 0.014, P = 0.015) significantly decreased, respectively, along with a significant reduction in EAG in the Lactobacillus plantarum (P = 0.031). A comparative analysis of lipid profiles across the four study groups is presented in Table 2 . There were no statistically significant differences in the means of serum levels of TC, TG, HDL, VLDL, and LDL among the groups at baseline. Comparison of the four study groups at the end of the study, adjusting for confounding variables of age, sex, baseline values, and BMI, revealed a significant decrease in total cholesterol (P = 0.008) and an increase in HDL (P = 0.046). The results of the post hoc test showed a substantial difference in the Lactobacillus plantarum compared to the control group. Furthermore, within-group analysis at the end of the study showed a significant decrease in TG (P = 0.032) and VLDL(P = 0.03) in the Lactobacillus plantarum group. However, the reduction of LDL in the L. plantarum was clinically important, although it was not statistically significant compared to the placebo group (percent change LDL: -7.23%). Discussion This randomized, triple-blind, placebo-controlled study assessed the strain-specific effects of Lactobacillus on the serum levels of omentin-1, glycemic markers, and lipid profile in obese people. According to our results, supplementation with three native strains of Lactobacillus did not significantly change omentin-1 levels compared to the placebo. In contrast, the results of Zarrati et al.(2019) showed that consuming probiotic yogurt containing 10^8 CFU/ml of Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium lactis for 8 weeks among overweight and obese individuals had a significant impact on omentin-1 [ 26 ]. The study by Sanchi et al. (2019) suggests that the probiotic Bifidobacterium pseudocatenulatum may significantly increase omentin-1 levels in obese children over 13 weeks [ 27 ]. Moreover, a Meta-analysis by Teixeira Cabral et al. showed that probiotics significantly increased omentin-1 levels [ 30 ]. Generally, discrepancies between results may be due to differences in the probiotics, sample size, intervention period, dosage, statistical analysis methods, and genetic differences among subjects. It appears that probiotics may potentially increase omentin levels through their anti-inflammatory properties, which help decrease fat accumulation in adipocytes by reducing fatty acid absorption and enhancing fatty acid oxidation [ 26 , 31 , 32 ]. According to other findings of this study, supplementation with three different native strains of Lactobacillus had no significant effect on any glycemic indices compared to the placebo. However, the within-group analyses showed that the supplementation with Lactobacillus plantarum and Lactobacillus fermentum significantly reduced QUICKI and insulin levels. Similar to our findings, Pellonpera et al. (2019) showed that probiotics didn’t affect insulin, HOMA-IR, and FBS in overweight and obese women [ 33 ]. Moreover, Higashikawa et al. (2016) conducted a 12-week study on overweight subjects, and the results showed that probiotic Pediococcus pentosaceus didn’t affect fasting plasma glucose, HbA1c, insulin, HOMA-IR, and serum lipid levels [ 34 ]. Consistent with our results, a meta-analysis by Barengolts et al showed that probiotic yogurt didn’t affect FBS, HOM-IR, Insulin, and A1c [ 29 ]. In contrast, a recent meta-analysis by Wang et al. showed that probiotics can reduce HbA1c, Insulin, and HOMA-IR, but they didn’t affect FBS [ 35 ]. A study by Hasani et al.(2024) found that three months of probiotic use ( Lactobacillus plantarum, Lactobacillus rhamnosus, Lactobacillus casei, and Bifidobacterium longum ) significantly lowered insulin levels in obese patients [ 36 ]. Moreover, results of Leila Rezazadeh et al. (2018) on 44 patients with metabolic syndrome consuming 300 g of probiotic yogurt containing ( Lactobacillus acidophilus, Bifidobacterium lactis ) daily for 2 months, showed a significant reduction in blood glucose levels, improved insulin, reduced HOMA-IR, and improved Quicki [ 37 ]. Overall, the hypoglycemic effect of probiotics has been reported primarily in diabetics or patients with metabolic syndrome and not in healthy obese adults. One proposed mechanism for the effects of probiotics on glycemic control is that the gut microbiome influences the release of enteroendocrine peptides, such as GLP-1, from gastrointestinal L cells. Changes in GLP-1 secretion can reduce gastric emptying and appetite, and increase insulin production, insulin sensitivity, and glucose uptake. Moreover, probiotics’ effective metabolites can impact glucose and lipid metabolism, improve insulin sensitivity, affect gastrointestinal neuropeptides, and regulate appetite [ 12 , 38 – 41 ]. Moreover, colonization of probiotics in the intestinal lining utilizes glucose as a primary source of energy and decreases intestinal glucose absorption [ 37 , 42 ]. The last finding of this study showed that supplementation with Lactobacillus plantarum significantly lowered total cholesterol and increased HDL levels compared to the placebo. The within-group analyses also showed a significant decrease in TG and VLDL levels only in group A ( Lactobacillus plantarum ). Similarly, Majewska et al. (2020) demonstrated that a 12-week supplementation with a multispecies probiotic in 50 obese women was associated with a significant decrease in total cholesterol (TC), low-density lipoprotein cholesterol (LDL), and triglyceride (TG) levels [ 19 ]. The study by Minami et al. (2018) demonstrated that the daily consumption of probiotic capsules for 12 weeks in 80 obese adults decreased triglyceride levels and improved HDL cholesterol [ 20 ]. More recently, Manohar KN et al. (2025) demonstrated that consuming a probiotic fiber blend resulted in significant reductions in triglycerides and an increase in HDL levels [ 21 ]. A study by Glauber et al. (2025) on obese adults found that probiotics can reduce LDL cholesterol and triglycerides, while also increasing HDL cholesterol [ 22 ]. Moreover, a recent meta-analysis reported a significant reduction in TG, but it did not affect cholesterol [ 28 ]. Although the mechanisms responsible for these beneficial effects of probiotics are not entirely clear, they might result from the attachment of probiotics to cholesterol, which helps decrease its absorption in the intestines. Moreover, probiotics may lower the enterohepatic recycling of bile salts, leading the liver to utilize more cholesterol for bile salt resynthesis, consequently decreasing cholesterol levels [ 43 – 45 ]. On the other hand, probiotics enhance the beta-oxidation of long-chain fatty acids in the liver and muscles. This modification affects the energy pathways involved in fatty acid oxidation, leading to a decrease in triglyceride synthesis [ 46 , 47 ]. Limitation Some limitations should be addressed to interpret the findings of this study. Firstly, the 8-week intervention duration may be too short to observe gut microbiota changes and detect meaningful changes in glycemic markers like HbA1c. Secondly, we can not assess the other adipokines due to financial limitations. Finally, individual variations in psychological stress and sleep patterns, which were not evaluated in this study, may have influenced the results. Conclusion In conclusion, 8 weeks of supplementation with native Lactobacillus strains did not significantly modify serum omentin-1 or glycemic indices in obese adults. Nevertheless, Lactobacillus plantarum exerted beneficial effects on lipid metabolism, including reductions in total cholesterol along with increased HDL levels, compared to placebo. These outcomes suggest that probiotic efficacy in obesity is strain-specific. Future clinical studies with larger sample sizes and longer duration are warranted to elucidate underlying mechanisms and confirm these preliminary findings. Declarations Acknowledgments The authors would like to express their appreciation to the participants of this study and to the Vice Chancellors for Research at Tabriz University of Medical Sciences and Alborz University of Medical Sciences for their support. Conflict of Interests None to be declared. Funding Tabriz university of medical sciences, Tabriz, Iran; Alborz University of Medical Sciences, Karaj, Iran. Authors’ contributions F.A.: Conceptualization of study; investigation; data curation; writing- original draft. L.RN, B.A ,J.G: Designing the study and data curation. 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Curr Opin Pharmacol 13(6):935–940 Rittiphairoj T, Pongpirul K, Janchot K, Mueller NT, Li T (2021) Probiotics contribute to glycemic control in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Adv Nutr 12(3):722–734 Yadav H, Jain S, Sinha P (2007) Antidiabetic effect of probiotic dahi containing Lactobacillus acidophilus and Lactobacillus casei in high fructose fed rats. Nutrition 23(1):62–68 Gilliland S, Nelson C, Maxwell C (1985) Assimilation of cholesterol by Lactobacillus acidophilus. Appl Environ Microbiol 49(2):377–381 Yan S, Tian Z, Li M, Li B, Cui W (2019) Effects of probiotic supplementation on the regulation of blood lipid levels in overweight or obese subjects: a meta-analysis. Food Funct 10(3):1747–1759 Mazloom Z, Yousefinejad A, Dabbaghmanesh MH (2013) Effect of probiotics on lipid profile, glycemic control, insulin action, oxidative stress, and inflammatory markers in patients with type 2 diabetes: a clinical trial. 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Br Poult Sci 56(2):218–224 Additional Declarations There is NO conflict of interest to disclose Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: revise 20 Mar, 2026 Review # 4 received at journal 09 Mar, 2026 Reviewer # 4 agreed at journal 09 Mar, 2026 Review # 3 received at journal 16 Feb, 2026 Reviewer # 3 agreed at journal 14 Feb, 2026 Review # 1 received at journal 17 Dec, 2025 Reviewer # 2 agreed at journal 04 Dec, 2025 Reviewer # 1 agreed at journal 04 Dec, 2025 Reviewers invited by journal 04 Dec, 2025 Submission checks completed at journal 30 Oct, 2025 Editor assigned by journal 25 Oct, 2025 First submitted to journal 25 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":357337,"visible":true,"origin":"","legend":"\u003cp\u003eStudy participants’ flowchart\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7956544/v1/ef886e2a3a1a6700dbefeb6d.png"},{"id":97700155,"identity":"cc1093e0-d3fc-477d-92fb-e3aca1963160","added_by":"auto","created_at":"2025-12-08 12:17:48","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":155170,"visible":true,"origin":"","legend":"\u003cp\u003eThe mechanism of probiotics in obesity management\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7956544/v1/25987bd1a7af19f28e1887c3.png"},{"id":98622067,"identity":"1a651705-0f0b-40d3-8a3c-898e5a519a7d","added_by":"auto","created_at":"2025-12-19 16:43:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1480346,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7956544/v1/8bb27d80-d3c4-4b51-97fe-c0327063a0ae.pdf"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e conflict of interest to disclose","formattedTitle":"Effects of native Lactobacillus rhamnosus, Lactobacillus fermentum, and Lactobacillus plantarum on serum level of omentin-1, glycemic markers, and lipid profile in obese adults: A triple-blind clinical trial","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eOverweight and obesity represent escalating global health challenges, as their prevalence is increasing considerably around the world [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. As reported by the World Health Organization (WHO), more than 1.9\u0026nbsp;billion adults are overweight, and around 650\u0026nbsp;million are suffering from obesity. It is also estimated that by 2030, one billion people worldwide will be living with obesity, which amounts to roughly 1 in 5 women and 1 in 7 men [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe etiology of overweight and obesity is multifactorial, involving an interplay between genetic predisposition, epigenetic modifications, neuroendocrine regulation, energy-dense diets, physical inactivity, and broader environmental and socioeconomic determinants [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These conditions are strongly associated with an elevated risk of cardiometabolic disorders\u0026mdash;including type 2 diabetes mellitus, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease\u0026mdash;as well as certain malignancies and degenerative joint diseases. Moreover, obesity is increasingly recognized as a state of chronic low-grade inflammation, contributing to systemic metabolic dysregulation [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOmentin is a recently identified adipokine predominantly expressed in visceral adipose tissue. Among its two known isoforms, omentin-1 is the primary circulating form and is considered to exert insulin-sensitizing, anti-inflammatory, and anti-atherogenic effects. Emerging evidence suggests that circulating levels of omentin are inversely associated with anthropometric indices in obesity, and it has been associated with hallmarks of obesity-related metabolic dysfunction [\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Besides the low-calorie diets and lifestyle modifications, the current repertoire of safe and effective treatments for obesity remains limited, and there is a need for new approaches to reduce the significant impact of obesity on health [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRecent studies have shown that dysbiosis, an imbalance in the gut microbiome, is linked to the onset of obesity [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Therefore, probiotics may have positive impacts on obesity and associated metabolic issues, including insulin resistance, hypertension, irregular lipid levels, and enhanced immune defense [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A variety of studies suggest that probiotics may help control and prevent obesity by enhancing microbial diversity, promoting the production of short-chain fatty acids, and regulating appetite [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Results of recent systematic reviews and meta-analyses also show some promising results of probiotics, including improvements in the Glycemic index [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and a significant reduction in the lipid profile [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, the results of studies on different probiotic genera are, to some extent, contradictory. For example, some studies have revealed the beneficial effects of probiotics and prebiotics on lipid profiles [\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], glycemic markers [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], and omentin-1 [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In contrast, some others have not achieved the same effect [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTherefore, the present study aimed to investigate the effects of three different native Iranian strains, including \u003cem\u003eLactobacillus rhamnosus, Lactobacillus fermentum, and Lactobacillus plantarum\u003c/em\u003e, on the serum level of omentin-1, glycemic markers, and lipid profile in obese subjects.\u003c/p\u003e"},{"header":"2. Methods and materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study design and subjects\u003c/h2\u003e\u003cp\u003eOne hundred eligible, healthy, obese subjects participated in this 8-week, triple-blind, placebo-controlled, randomized clinical trial. The sample size was calculated based on the change in waist circumference (WC) levels, one of our primary variables, as reported in the study conducted by Zarati et al. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], with α = 0.05 and a power of 90%, resulting in 22 participants per group. By considering a 15% dropout, 25 individuals were assigned to each group. Participants were recruited through a general call schedule across the city of Karaj, Iran. The inclusion criteria were both sexes, aged 18–60 years, with a body mass index (BMI) of 30–40 kg/m². Exclusion criteria were pregnant or breastfeeding women, smokers, regular consumers of nutritional supplements and probiotics, consumers of corticosteroids, gastric surgery, thyroid problems, a history of diabetes and kidney disease, weight loss within the last 3 months, and intense physical activity. The study was accepted by the Ethical Committee of Alborz University of Medical Sciences (IR.ABZUMS.REC.1401.054) and Tabriz University of Medical Sciences ( IR.TBZMED.REC.1403.362). It was also registered in the Iranian Registry of Clinical Trials (IRCT20220608055106N1). All participants read and signed an informed consent form before study enrollment.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 \u003cb\u003eRandomization and Intervention\u003c/b\u003e\u003c/h2\u003e\u003cp\u003eParticipants were randomly assigned to four groups (25 participants in each group) using a block randomization procedure. The members, the leading researcher, and the statistical advisor were blind until the end of the study. All groups consumed one sachet of probiotics (Shams Bavaran Salamat Nour Company, Tehran, Iran) mixed with water before meals for 60 days. The first group took probiotic supplements in the form of powder sachets containing native \u003cem\u003eLactobacillus fermentum\u003c/em\u003e NIMBB014 (2 × 10^9 CFU), isolated from the Komeh product (registration code: NCBI MT994667). The second group took powder supplements containing native \u003cem\u003eLactobacillus rhamnosus\u003c/em\u003e NIMBB006 (2 × 10^9 CFU), isolated from the mother’s milk (registration code: NCBI MT995144). The third group took supplements containing \u003cem\u003eLactobacillus plantarum\u003c/em\u003e (2 × 10^9 CFU), isolated from camel milk (registration code: 012188, NCBI MT). The fourth group received a placebo consisting of 100% maltodextrin without flavor, in a 1-gram sachet, for 60 days.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 \u003cb\u003eAssessments\u003c/b\u003e\u003c/h2\u003e\u003cp\u003eBlood samples were collected after a 10-to 12-hour overnight fast at baseline and at the end of the study. Serum samples were divided by centrifugation and stored at − 80°C until analysis. The serum level of omentin-1 was measured using the human ELISA kit (Zellbio GmbH, Ulm, Germany). The levels of Serum LDL, HDL, TC, TG, VLDL, FBC, HbA1c, and α-amylase were measured by the enzymatic colorimetric methods on an automatic analyzer (Abbott, model Alcyon 300, USA). Serum insulin concentrations were quantified utilizing a human-specific ELISA kit (Monobind Inc., Lake Forest, CA, USA). Insulin resistance index was estimated by the homeostasis model assessment of insulin resistance (HOMA-IR) calculated using the formula: [fasting serum insulin (µU/ml) × fasting serum glucose (mg/dl)/405] (50). Additionally, insulin sensitivity was assessed using the quantitative insulin sensitivity check index (QUICKI), calculated according to the following formula: [1/log insulin (µU/mL) + log glucose (mg/dL)] (50). Weight and height were also measured using a standard scale (Seca, Hamburg, Germany), with participants wearing only slight clothing and no shoes. Body mass index (BMI) was calculated by dividing weight (in kilograms) by the square of height (in meters). Dietary intake was evaluated using a validated 168-item food frequency questionnaire (FFQ). The nutrient composition and dietary data were subsequently analyzed using the Nutritionist IV software “Nutritionist 4” (First Databank Inc., Hearst Corp., and San Bruno, CA, USA).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 \u003cb\u003eStatistical analysis\u003c/b\u003e\u003c/h2\u003e\u003cp\u003eStatistical analyses were conducted using SPSS software, version 23.0 (IBM Corp., Armonk, NY, USA). The normality of data distribution was evaluated using the Kolmogorov–Smirnov test, alongside assessments of mean and SD. Possible differences at baseline among treatment groups were assessed by the one-way ANOVA test for normally distributed parameters. At the end of the study, analysis of covariance (ANCOVA) was conducted for parameters exhibiting normal distribution, incorporating baseline values, BMI, age, sex, and caloric intake as covariates. Furthermore, within-group differences in biochemical parameters were evaluated using the paired-sample t-test for normally distributed data and the Wilcoxon signed-rank test for non-parametric data. Percent changes between groups were computed using the formula outlined: (Mean \u003csub\u003eintervention\u003c/sub\u003e – Mean \u003csub\u003eplacebo\u003c/sub\u003e ) ÷ Mean \u003csub\u003eplacebo\u003c/sub\u003e ×100. Also, the percent change within groups was calculated using the following formula: (Mean \u003csub\u003eafter\u003c/sub\u003e -Mean \u003csub\u003ebefore\u003c/sub\u003e) ÷ Mean \u003csub\u003ebefore\u003c/sub\u003e ×100. P \u0026lt; 0.05 was considered indicative of statistical significance.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Result","content":"\u003cp\u003eAs illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, a total of 100 eligible volunteers were enrolled in the study, with each of the four groups comprising 25 participants (17 women and 8 men). However, 11 individuals did not complete the intervention. In the \u003cem\u003eLactobacillus plantarum\u003c/em\u003e group, two participants withdrew—one female due to pregnancy and one male due to travel commitments. In the \u003cem\u003eLactobacillus fermentum\u003c/em\u003e group, one male participant was excluded for failing to adhere to supplement intake. Within the placebo group, five women discontinued participation: two due to non-compliance with supplement consumption, one following a diagnosis of hypothyroidism, and two due to the use of anti-obesity medications. In the \u003cem\u003eLactobacillus rhamnosus\u003c/em\u003e group, three participants dropped out—two (one male and one female) due to travel, and one female following a diagnosis of hypothyroidism. Importantly, no participant discontinued the study as a result of adverse effects related to either the probiotic interventions or the placebo. Baseline characteristics of the study population are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline data of the Study Subjects in the four study groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003evariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLactobacillus plantarum (A)\u003c/p\u003e\u003cp\u003e(n = 23)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLactobacillus fermentum (B)\u003c/p\u003e\u003cp\u003e(n = 24)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLactobacillus rhamnosus (D)\u003c/p\u003e\u003cp\u003e(n = 22)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePlacebo group(C)\u003c/p\u003e\u003cp\u003e(n = 20)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.742\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (24.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(24.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (24.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8 (27.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16(26.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17(28.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15(25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12 (20%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge(y)\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40.04 ± 12.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45.75 ± 10.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46.59 ± 9.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e44.90\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e12.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.197\u003csup\u003e\u003cb\u003e†\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eilleterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnder diploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (17.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (56.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.286\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ediploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (30%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (20%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (26.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (23.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003euniversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (28.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (14.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (31.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9 (25.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (30%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 ( 20%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (20%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (30%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.857\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (25.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (27.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20 (25.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17 (21.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHight\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.64 ± 0.095\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.66 ± 0.076\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.69 ± 0.079\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.64 ± 0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.278\u003csup\u003e\u003cb\u003e†\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWeight(kg)\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90.23 ± 11.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91.50 ± 11.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92.74 ± 11.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e87.52 ± 10.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.486\u003csup\u003e\u003cb\u003e†\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI(Kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33.21 ± 3.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.84 ± 3.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.24 ± 3.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32.33 ± 4.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.777\u003csup\u003e\u003cb\u003e†\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e*values ​​are reported as mean ± SD\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e**\u003c/sup\u003ebased on the Chi-Square test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u003cb\u003e†\u003c/b\u003e\u003c/sup\u003ebased on one-way ANOVA test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e#based on Kruskal-Wallis H test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe results of the comparative analysis of omentin-1 in the four groups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. There was a statistically significant difference in serum levels of omentin-1 among the groups at baseline. However, at the end of the study, after adjusting for confounding variables (age, sex, baseline values, and BMI), there were no statistically significant differences in omentin-1 levels among groups. Assessment of within-group changes did not show any statistically significant increase in omentin-1 levels in any of the groups. However, the change in omentin-1 in the \u003cem\u003eLactobacillus rhamnosus\u003c/em\u003e group was clinically substantial (percent changes:3.57% ).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of levels of omentin-1, glycemic markers, and lipid profile parameter values ​​in the four study groups before and after the intervention\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003evariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLactobacillus plantarum(A)\u003c/p\u003e\u003cp\u003e(n = 23)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLactobacillus fermentum(B)\u003c/p\u003e\u003cp\u003e(n = 24)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eLactobacillus rhamnosus(D)\u003c/p\u003e\u003cp\u003e(n = 22)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePlacebo group(C)\u003c/p\u003e\u003cp\u003e(n = 20)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eOmentin-1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.34 ± 1.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.36 ± 1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e7.83 ± 2.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.488 ± 1.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.014\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAfter 8 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.42 ± 0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.87 ± 1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e8.11 ± 0.930\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6.98 ± 1.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.214\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.422\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.599\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.470\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFBS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96.04 ± 6.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e97.29 ± 8.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e98.55 ± 8.075\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e99.90 ± 10.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.482\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAfter 8 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97.26 ± 7.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e96.25 ± 7.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e97.18 ± 8.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e97.85 ± 8.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.339\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.348\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.276\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.283\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eHbA1C\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.49 ± 0.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e5.60 ± 0.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.586 ± 0.357\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5.45 ± 0.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.582\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAfter 8 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.40 ± 0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e5.52 ± 0.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.605 ± 0.283\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5.50 ± 0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.520\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.687\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.510\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eE AG\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e109.78 ± 12.717\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e113.42 ± 10.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e113.82 ± 10.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e108.60 ± 9.768\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.305\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAfter 8 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e106.04 ± 10.173\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e111.46 ± 10.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e114.23 ± 8.280\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e110 ± 11.761\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.179\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.031\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.188\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.757\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.521\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eHOM-IR\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.29 ± 1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e2.617 ± 1.107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.691 ± 1.099\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.39 ± 0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.511\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAfter 8 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.45± 0.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e2.356 ± 0.615\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.530 ± 0.637\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.27 ± 0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.535\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.503\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.449\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.498\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eQuicki\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.34 ± 0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.348 ± 0.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.338 ± 0.0375\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.331 ± 0.031\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.278\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAfter 8 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.33 ± 0.018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.329 ± 0.0237\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.329 ± 0.0120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.333 ± 0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.602\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.307\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.777\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eInsulin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.44 ± 4.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e9.695 ± 5.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9.924 ± 4.918\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e9.46 ± 3.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.728\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAfter 8 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.64 ± 3.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e13.302 ± 6.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11.665 ± 3.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11.14 ± 3.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.417\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.225\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eAmylase\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59.37 ± 17.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e49.58 ± 12.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e58.05 ± 15.521\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e51.27 ± 11.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.322\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAfter 8 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58.34 ± 16.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e52.35 ± 12.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e60.57 ± 17.352\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e54.57 ± 16.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.769\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.545\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.212\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.377\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTC\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e175.04 ± 26.453\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e177.58 ± 33.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e181.45 ± 28.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e165.50 ± 29.747\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.357\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAfter 8 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e159.43 ± 26.483\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e182.08 ± 36.23\u003csup\u003efa\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e185.86 ± 38.47\u003csup\u003eha\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e171.75 ± 35.22\u003csup\u003ega\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.008\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.395\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.456\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.070\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eLDL\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96.43 ± 21.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e95.75 ± 31.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e102 ± 27.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e91 ± 24.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.614\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAfter 8 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e90.91 ± 29.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e101.63 ± 29.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e95.86 ± 33.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e98 ± 28.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.20\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.231\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.380\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eHDL\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.52 ± 6.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e51.42 ± 8.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e41.23 ± 7.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e44.55 ± 8.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAfter 8 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.22 ± 7.82\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e52.08 ± 8.91\u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e40.64 ± 6.39\u003csup\u003eef\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e45.60 ± 9.13\u003csup\u003eef\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.046\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eP\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.508\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.575\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.364\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eVLDL\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29.91 ± 11.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e26.38 ± 10.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e33.05 ± 15.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e29.30 ± 11.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.357\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAfter 8 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25.83 ± 10.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e24.96 ± 8.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e33.18 ± 13.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e26.20 ± 9.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.153\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eP\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.384\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.954\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eTG\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e145.39 ± 49.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e132.75 ± 45.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e169.41 ± 63.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e147.20 ± 56.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.151\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAfter 8 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e126.52 ± 48.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e124.25 ± 43.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e167.95 ± 61.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e131.30 ± 46.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.176\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eP\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.290\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.846\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.042\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eAll values are reported as mean ± SD\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003ea One-way ANOVA test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eb analysis of covariance (ANCOVA) adjusting for age, sex, baseline values, and BMI\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003ec Paired samples t-test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe results of glycemic parameters across the four study groups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. There were no statistically significant differences in serum levels of FBS, A1C, Insulin, QUICKI, HOM-IR, EAG, and α-Amylase among the groups at baseline and also after the end of 8 weeks of intervention. Furthermore, within-group analyses showed that QUICKI and Insulin levels in the \u003cem\u003eLactobacillus fermentum\u003c/em\u003e (P = 0.005 and P\u003csub\u003e=\u003c/sub\u003e0.009) and \u003cem\u003eLactobacillus plantarum\u003c/em\u003e (P = 0.014, P = 0.015) significantly decreased, respectively, along with a significant reduction in EAG in the \u003cem\u003eLactobacillus plantarum\u003c/em\u003e (P = 0.031).\u003c/p\u003e\u003cp\u003eA comparative analysis of lipid profiles across the four study groups is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. There were no statistically significant differences in the means of serum levels of TC, TG, HDL, VLDL, and LDL among the groups at baseline. Comparison of the four study groups at the end of the study, adjusting for confounding variables of age, sex, baseline values, and BMI, revealed a significant decrease in total cholesterol (P = 0.008) and an increase in HDL (P = 0.046). The results of the post hoc test showed a substantial difference in the \u003cem\u003eLactobacillus plantarum\u003c/em\u003e compared to the control group. Furthermore, within-group analysis at the end of the study showed a significant decrease in TG (P = 0.032) and VLDL(P = 0.03) in the \u003cem\u003eLactobacillus plantarum\u003c/em\u003e group. However, the reduction of LDL in the \u003cem\u003eL. plantarum\u003c/em\u003e was clinically important, although it was not statistically significant compared to the placebo group (percent change LDL: -7.23%).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis randomized, triple-blind, placebo-controlled study assessed the strain-specific effects of \u003cem\u003eLactobacillus\u003c/em\u003e on the serum levels of omentin-1, glycemic markers, and lipid profile in obese people. According to our results, supplementation with three native strains of \u003cem\u003eLactobacillus\u003c/em\u003e did not significantly change omentin-1 levels compared to the placebo.\u003c/p\u003e\u003cp\u003eIn contrast, the results of Zarrati et al.(2019) showed that consuming probiotic yogurt containing 10^8 CFU/ml of \u003cem\u003eLactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium lactis\u003c/em\u003e for 8 weeks among overweight and obese individuals had a significant impact on omentin-1 [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The study by Sanchi et al. (2019) suggests that the probiotic Bifidobacterium pseudocatenulatum may significantly increase omentin-1 levels in obese children over 13 weeks [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Moreover, a Meta-analysis by Teixeira Cabral et al. showed that probiotics significantly increased omentin-1 levels [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGenerally, discrepancies between results may be due to differences in the probiotics, sample size, intervention period, dosage, statistical analysis methods, and genetic differences among subjects. It appears that probiotics may potentially increase omentin levels through their anti-inflammatory properties, which help decrease fat accumulation in adipocytes by reducing fatty acid absorption and enhancing fatty acid oxidation [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to other findings of this study, supplementation with three different native strains of \u003cem\u003eLactobacillus\u003c/em\u003e had no significant effect on any glycemic indices compared to the placebo. However, the within-group analyses showed that the supplementation with \u003cem\u003eLactobacillus plantarum\u003c/em\u003e and \u003cem\u003eLactobacillus fermentum\u003c/em\u003e significantly reduced QUICKI and insulin levels. Similar to our findings, Pellonpera et al. (2019) showed that probiotics didn\u0026rsquo;t affect insulin, HOMA-IR, and FBS in overweight and obese women [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Moreover, Higashikawa et al. (2016) conducted a 12-week study on overweight subjects, and the results showed that probiotic Pediococcus pentosaceus didn\u0026rsquo;t affect fasting plasma glucose, HbA1c, insulin, HOMA-IR, and serum lipid levels [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Consistent with our results, a meta-analysis by Barengolts et al showed that probiotic yogurt didn\u0026rsquo;t affect FBS, HOM-IR, Insulin, and A1c [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In contrast, a recent meta-analysis by Wang et al. showed that probiotics can reduce HbA1c, Insulin, and HOMA-IR, but they didn\u0026rsquo;t affect FBS [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. A study by Hasani et al.(2024) found that three months of probiotic use (\u003cem\u003eLactobacillus plantarum, Lactobacillus rhamnosus, Lactobacillus casei, and Bifidobacterium longum\u003c/em\u003e) significantly lowered insulin levels in obese patients [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Moreover, results of Leila Rezazadeh et al. (2018) on 44 patients with metabolic syndrome consuming 300 g of probiotic yogurt containing (\u003cem\u003eLactobacillus acidophilus, Bifidobacterium lactis\u003c/em\u003e) daily for 2 months, showed a significant reduction in blood glucose levels, improved insulin, reduced HOMA-IR, and improved Quicki [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOverall, the hypoglycemic effect of probiotics has been reported primarily in diabetics or patients with metabolic syndrome and not in healthy obese adults. One proposed mechanism for the effects of probiotics on glycemic control is that the gut microbiome influences the release of enteroendocrine peptides, such as GLP-1, from gastrointestinal L cells. Changes in GLP-1 secretion can reduce gastric emptying and appetite, and increase insulin production, insulin sensitivity, and glucose uptake. Moreover, probiotics\u0026rsquo; effective metabolites can impact glucose and lipid metabolism, improve insulin sensitivity, affect gastrointestinal neuropeptides, and regulate appetite [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR39 CR40\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Moreover, colonization of probiotics in the intestinal lining utilizes glucose as a primary source of energy and decreases intestinal glucose absorption [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe last finding of this study showed that supplementation with \u003cem\u003eLactobacillus plantarum\u003c/em\u003e significantly lowered total cholesterol and increased HDL levels compared to the placebo. The within-group analyses also showed a significant decrease in TG and VLDL levels only in group A (\u003cem\u003eLactobacillus plantarum\u003c/em\u003e). Similarly, Majewska et al. (2020) demonstrated that a 12-week supplementation with a multispecies probiotic in 50 obese women was associated with a significant decrease in total cholesterol (TC), low-density lipoprotein cholesterol (LDL), and triglyceride (TG) levels [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The study by Minami et al. (2018) demonstrated that the daily consumption of probiotic capsules for 12 weeks in 80 obese adults decreased triglyceride levels and improved HDL cholesterol [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. More recently, Manohar KN et al. (2025) demonstrated that consuming a probiotic fiber blend resulted in significant reductions in triglycerides and an increase in HDL levels [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. A study by Glauber et al. (2025) on obese adults found that probiotics can reduce LDL cholesterol and triglycerides, while also increasing HDL cholesterol [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Moreover, a recent meta-analysis reported a significant reduction in TG, but it did not affect cholesterol [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough the mechanisms responsible for these beneficial effects of probiotics are not entirely clear, they might result from the attachment of probiotics to cholesterol, which helps decrease its absorption in the intestines. Moreover, probiotics may lower the enterohepatic recycling of bile salts, leading the liver to utilize more cholesterol for bile salt resynthesis, consequently decreasing cholesterol levels [\u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. On the other hand, probiotics enhance the beta-oxidation of long-chain fatty acids in the liver and muscles. This modification affects the energy pathways involved in fatty acid oxidation, leading to a decrease in triglyceride synthesis [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSome limitations should be addressed to interpret the findings of this study. Firstly, the 8-week intervention duration may be too short to observe gut microbiota changes and detect meaningful changes in glycemic markers like HbA1c. Secondly, we can not assess the other adipokines due to financial limitations. Finally, individual variations in psychological stress and sleep patterns, which were not evaluated in this study, may have influenced the results.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, 8 weeks of supplementation with native \u003cem\u003eLactobacillus\u003c/em\u003e strains did not significantly modify serum omentin-1 or glycemic indices in obese adults. Nevertheless, \u003cem\u003eLactobacillus plantarum\u003c/em\u003e exerted beneficial effects on lipid metabolism, including reductions in total cholesterol along with increased HDL levels, compared to placebo. These outcomes suggest that probiotic efficacy in obesity is strain-specific. Future clinical studies with larger sample sizes and longer duration are warranted to elucidate underlying mechanisms and confirm these preliminary findings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their appreciation to the participants of this study and to the Vice Chancellors for Research at Tabriz University of Medical Sciences and Alborz University of Medical Sciences for their support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone to be declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTabriz university of medical sciences, Tabriz, Iran; Alborz\u0026nbsp;University of Medical Sciences, Karaj, Iran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eF.A.: Conceptualization of study; investigation; data curation; writing- original draft.\u003c/p\u003e\n\u003cp\u003eL.RN, B.A ,J.G: Designing the study and data curation.\u003c/p\u003e\n\u003cp\u003eV.E.: Conceptualization and supervision of study; data analyses, interpretation of data and critical revision of the manuscript\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKim H, Jeong Y, Kim J-E, Kim Y, Paek N-S, Kang C-H (2021) Anti-obesity potential of Lactobacillus spp. isolated from infant feces. 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Appl Environ Microbiol 49(2):377\u0026ndash;381\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYan S, Tian Z, Li M, Li B, Cui W (2019) Effects of probiotic supplementation on the regulation of blood lipid levels in overweight or obese subjects: a meta-analysis. Food Funct 10(3):1747\u0026ndash;1759\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMazloom Z, Yousefinejad A, Dabbaghmanesh MH (2013) Effect of probiotics on lipid profile, glycemic control, insulin action, oxidative stress, and inflammatory markers in patients with type 2 diabetes: a clinical trial. Iran J Med Sci 38(1):38\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaramali M, Dadkhah F, Sadrkhanlou M, Jamilian M, Ahmadi S, Tajabadi-Ebrahimi M et al (2016) Effects of probiotic supplementation on glycaemic control and lipid profiles in gestational diabetes: A randomized, double-blind, placebo-controlled trial. 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Br Poult Sci 56(2):218\u0026ndash;224\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"nutrition-and-diabetes","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"nutd","sideBox":"Learn more about [Nutrition \u0026 Diabetes](http://www.nature.com/nutd/)","snPcode":"41387","submissionUrl":"https://mts-nutd.nature.com/cgi-bin/main.plex","title":"Nutrition \u0026 Diabetes","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Probiotics, Lactobacillus, Omentin-1, Obesity, Lipid profile, Glycemic control","lastPublishedDoi":"10.21203/rs.3.rs-7956544/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7956544/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Obesity is a multifactorial disorder strongly associated with metabolic dysfunction and chronic inflammation. Emerging evidence suggests that modulation of the gut microbiota through probiotic supplementation may improve metabolic outcomes. This study investigated the effects of three native \u003cem\u003eLactobacillus\u003c/em\u003e strains on serum omentin-1 levels, glycemic indices, and lipid profiles in obese adults.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e In this 8-week, triple-blind, randomized, placebo-controlled clinical trial, 100 obese adults (BMI 30–40 kg/m²) were assigned to four groups receiving daily sachets containing \u003cem\u003eLactobacillus fermentum\u003c/em\u003e NIMBB014, \u003cem\u003eLactobacillus rhamnosus\u003c/em\u003e NIMBB006, \u003cem\u003eLactobacillus plantarum\u003c/em\u003e (2 × 10⁹ CFU), or placebo. Serum omentin-1, anthropometric, glycemic (FBS, HbA1c, insulin, HOMA-IR, QUICKI, serum α-amylase), and lipid (TC, TG, HDL, LDL, VLDL) parameters were assessed at baseline and after 8 weeks. Data were analyzed using the paired t-tests and ANCOVA, adjusting for age, sex, baseline values, and BMI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e After 8 weeks, no significant between-group differences were observed in omentin-1 or glycemic indices. However, within-group analyses indicated significant reductions in insulin and QUICKI in both the \u003cem\u003eL. fermentum and L. plantarum\u003c/em\u003e groups (P \u0026lt; 0.05). \u003cem\u003eL. plantarum\u003c/em\u003esupplementation resulted in a significant decrease in total cholesterol (P = 0.008) and an increase in HDL (P = 0.046) compared with placebo, along with significant within-group reductions in TG and VLDL (P \u0026lt; 0.05). No adverse effects were reported.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e These findings suggest strain-specific probiotic benefits in obesity management, warranting longer interventions and larger trials to confirm metabolic effects.\u003c/p\u003e","manuscriptTitle":"Effects of native Lactobacillus rhamnosus, Lactobacillus fermentum, and Lactobacillus plantarum on serum level of omentin-1, glycemic markers, and lipid profile in obese adults: A triple-blind clinical trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 12:17:43","doi":"10.21203/rs.3.rs-7956544/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2026-03-20T19:08:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-03-09T14:39:07+00:00","index":4,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2026-03-09T14:30:39+00:00","index":4,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-02-16T05:39:32+00:00","index":3,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2026-02-14T05:38:42+00:00","index":3,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-12-18T01:34:27+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-12-04T20:56:38+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-12-04T20:30:27+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2025-12-04T20:29:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-30T09:28:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-25T14:46:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"Nutrition \u0026 Diabetes","date":"2025-10-25T14:46:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"nutrition-and-diabetes","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"nutd","sideBox":"Learn more about [Nutrition \u0026 Diabetes](http://www.nature.com/nutd/)","snPcode":"41387","submissionUrl":"https://mts-nutd.nature.com/cgi-bin/main.plex","title":"Nutrition \u0026 Diabetes","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a22a0345-a870-47a0-bed6-cae7d9310807","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":59120396,"name":"Health sciences/Diseases"},{"id":59120397,"name":"Health sciences/Diseases/Nutrition disorders/Obesity"}],"tags":[],"updatedAt":"2026-05-13T08:05:56+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 12:17:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7956544","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7956544","identity":"rs-7956544","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}