Supplementation with inulin-type fructans affects gut microbiota and attenuates some of the cardiometabolic benefits of a plant-based diet in individuals with overweight or obesity

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Background: The gut microbiota has emerged as a potential therapeutic target to improve the management of obesity and its comorbidities. 

Objective: We investigated the impact of a high fiber (∼38 g/d) plant-based diet, consumed ad libitum, with or without added inulin-type fructans (ITF), on the gut microbiota composition and cardiometabolic outcomes in subjects with obesity. We also tested if baseline Prevotella/Bacteroides (P/B) ratio predicts weight loss outcomes. 

Methods: This is a secondary exploratory analysis from the PREVENTOMICS study, in which 100 subjects (82 completers) aged 18–65 years with body mass index 27–40 kg/m2 were randomized to 10 weeks of double-blinded treatment with a personalized or a generic plant-based diet. Changes from baseline to end-of-trial in gut microbiota composition (16S rRNA gene amplicon sequencing), body composition, cardiometabolic health and inflammatory markers were evaluated in the whole cohort (n = 82), and also compared in the subgroup of subjects who were supplemented with an additional 20 g/d ITF-prebiotics (n = 21) or their controls (n = 22). Results: In response to the plant-based diet, all subjects lost weight (−3.2 [95% CI –3.9, −2.5] kg) and experienced significant improvements in body composition and cardiometabolic health indices. Addition of ITF to the plant-based diet reduced microbial diversity (Shannon index) and selectively increased Bifidobacterium and Faecalibacterium (q < 0.05). The change in the latter was significantly associated with higher values of insulin and HOMA-IR and lower HDL cholesterol. In addition, the LDL:HDL ratio and the concentrations of IL-10, MCP-1 and TNFα were significantly elevated in the ITF-subgroup. There was no relationship between baseline P/B ratio and changes in body weight (r = −0.07, p = 0.53). 

Conclusion: A plant-based diet consumed ad libitum modestly decreases body weight and has multiple health benefits in individuals with obesity. Addition of ITF-prebiotics on top this naturally fiber-rich background selectively changes gut microbiota composition and attenuates some of the realized cardiometabolic benefits. 

Clinical trial registration: [], identifier [NCT04590989].

TidsskriftFrontiers in Nutrition
Antal sider13
StatusUdgivet - 2023

Bibliografisk note

CURIS 2023 NEXS 142

Funding Information:
The PREVENTOMICS project was supported by the European Union’s Horizon 2020 research and innovation program under grant agreement no. 818318, but no additional funding was received for the current analysis. Work on gut microbiome quantification in feces in addition to some of the study materials was funded by a PhD scholarship from King Saud bin Abdulaziz University for Health Sciences via The Saudi Arabian Cultural Office.

Publisher Copyright:
Copyright © 2023 Aldubayan, Mao, Laursen, Pigsborg, Christensen, Roager, Nielsen, Hjorth and Magkos.

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