Choosing prokinetic agents: The 1st five things you should consider

　A very interesting field of research in metabolic disorders that has gained attention recently is the possible role of gut microbiota in the development of obesity. Obesity is a complex disease resulting from a prolonged imbalance of energy input and energy expenditure. Inappropriate dietary and exercise habits are major contributing factors but it is now understood that the composition and function of the gut microbiota plays an important role in the development of obesity through a variety of mechanisms. It has been shown that obese and lean subjects present different microbiota composition profile. Many studies have reported the difference in the composition of gut microbiota between obese and lean individuals, both in animal models as well as in humans, with a decrease in Bacteroidetes proportion and an increase in Firmicutes proportion.
　These differences in microbiota composition may contribute to weight imbalance and impaired metabolism. It is evident that the gut microbiota modulates intestinal barrier function and immune responsiveness. The utilization of food is influenced by the gut microbiome, vice versa, specific nutrients such as high-fat/energy diet can alter the gut microbiota composition which can activate lipogenic pathways and reciprocally creates excessive energy harvesting and storage. The interaction of gut microbiota with the endocannabinoid system provides a route through which intestinal permeability can be altered. Further, microbial imbalance increases gut permeability, leading to metabolic endotoxemia, inflammation and insulin resistance.
　The fact that gut microbiota can be modulated through dietary components highlights the importance to study how probiotics, prebiotics, and nutrition can influence gut microbiota composition and the management of obesity. However, we cannot conclude at this time that specific genera, classes, or species of gut microbes are always positively or negatively correlated with the obese phenotype.
　In summary, Probiotics have many beneficial health effects in humans and animals. Its effects on manipulation or modulation of the gut microbiota is an alternative option that merits an interesting approach on the control of obesity in humans. At present there is no consensus on the specific pattern(s) of gut bacteria that are involved in the etiology and thus can be a biomarker/therapeutic target for obesity due to the inconsistent results of different studies. Additional clinical and preclinical studies are needed to illustrate the definite role of specific bacteria species/groups in obesity.