Probiotic Interventions in Coeliac Disease: A Systematic Review with a Focus on Cardiovascular Risk

Abstract

People with coeliac disease (CD) have a higher risk of developing cardiovascular disease (CVD), potentially due to inflammation. Probiotics can influence CVD risk through several mechanisms including modifying inflammation. We performed a systematic review of probiotic interventions in people with CD. In total, 4 databases were systematically searched for studies published up to March 2023. All outcomes, inclusive of any cardiovascular risk factors, were collated and reported. We screened 8084 articles and 11 publications reporting on 7 RCTs and 2 non-RCTs met the inclusion criteria for qualitative analysis. In total, 1 RCT and both non-RCTs were considered to have a high risk of bias. There was large heterogeneity between the studies and adherence to a gluten-free diet was only measured in two studies. No specific outcomes related to cardiovascular risk were reported. Two studies reported a significant reduction on serum TNF-α in children over time after probiotic supplementation. One study reported no significant change in intestinal permeability over a 3-week intervention. Currently there is insufficient evidence to advocate a positive impact of probiotics on inflammation in CD, due, in part, to the limited data on adherence to the gluten-free diet and active disease.