The number of participants The trial followed the principle of intention analysis, 100 participants were involved in the result analysis, and there were no shedding cases, as shown in Figure 1. "

Comparison of general data and a 24-hour retrospective dietary survey, a lifestyle survey, a medical history, and family history between study groups before the nutritional intervention There were no significant difference in the general data among four groups, including  case number, age, sex, smoking, alcohol usage, and high blood pressure (P > 0.05), but the weekly physical activity and protein energy ratio were lower in obese subjects than healthy controls (P < 0.01). Daily total energy intake, fat energy ratio, abnormal glucose metabolism, and the prevalence of carotid atherosclerosis were significantly increased in three obese patients (groups A, B, C) than normal control group (group D) (P < 0.05 or  P < 0.01). These results indicate that obesity is a high-risk factor for abnormal glucose metabolism and atherosclerosis (Table 1).  "

Changes in body composition and lipid metabolism Before intervention: BMI, waist-hip ratio, fat mass, TG, TC, and LDL-c were significantly higher in obese groups than in the healthy control group (P < 0.05), and there was no significant difference among the three intervention groups (P > 0.05; Table 2). After nutritional intervention, the parameters of BMI, waist-hip ratio and fat mass in obese subjects fed with low-carbon diet with or without microecological preparation were significantly improved (P < 0.05). Obese patients given microecological preparation combined with low-carbon diet exhibited better improvement in BMI and fat mass than those with low-carbon diet alone. These results suggest that microecological preparation combined with low-carbon diet is more effective to reduce body fat and BMI than a low-carbon diet alone (Table 2). Microecological preparation combined with low-carbon diet or single low-carbon diet intervention significantly improved serum lipid profiles, including reduction of TG, TC, and LDLc (P < 0.05; Table 2). The levels of TC and LDLc were lower in obese patients given microecological preparation combined with low-carbon diet than those given single low-carbon diet (P < 0.01). These results reveal that microecological preparation combined with low-carbon diet is more effective to reduce serum hyperlipidemia than low-carbon diet alone. "

Pathological changes in hepatic remodeling After 3-month intervention, the incidence and severity (Table 3) of non-alcoholic fatty liver disease were decreased in obese patients given both microecological preparation combined with low-carbon diet and single low-carbon diet, and combined treatment of microecological preparation and low-carbon diet had better clinical outcomes. These results suggest that microecological preparation combined with low-carbon diet is more effective to reduce the severity of fatty liver disease than a low-carbon diet alone. "

Changes in intestinal barrier function Before the intervention, serum levels of D-lactic acid, diamine oxidase and bacterial LPS were significantly higher in obese subjects, as compared with healthy subjects (P < 0.05). Whereas serum levels of D-lactic acid,diamine oxidase and LPS were significantly decreased in subjects fed with two intervention (P < 0.05). More importantly, the serum levels of D-lactic acid,diamine oxidase and LPS were lower in subjects treated with microecological preparation and low-carbon diet than with single low-carbon diet (P < 0.05).  These results suggested that microecological preparation combined improved low-carbon diet had better effective than improved low-carbon diet alone in repairing intestinal mucosal damage, reducing intestinal permeability, and inhibiting LPS translocation (Table 4). Adverse reaction events No adverse reaction was found in each group during the trial."