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Original article
Multivariate modelling of faecal bacterial profiles of patients with IBS predicts responsiveness to a diet low in FODMAPs
  1. Sean M P Bennet1,2,
  2. Lena Böhn1,3,
  3. Stine Störsrud1,3,
  4. Therese Liljebo4,
  5. Lena Collin5,
  6. Perjohan Lindfors1,5,6,
  7. Hans Törnblom1,3,
  8. Lena Öhman1,2,7,
  9. Magnus Simrén1,3
  1. 1Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  2. 2Department of Microbiology and Immunology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  3. 3Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  4. 4Department of Nutrition, Karolinska University Hospital, Stockholm, Sweden
  5. 5Department of Gastroenterology, Sabbatsbergs Hospital, Stockholm, Sweden
  6. 6Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
  7. 7School of Health and Education, University of Skövde, Skövde, Sweden
  1. Correspondence to Professor Magnus Simrén, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg 405 30, Sweden; magnus.simren{at}medicine.gu.se

Abstract

Objective The effects of dietary interventions on gut bacteria are ambiguous. Following a previous intervention study, we aimed to determine how differing diets impact gut bacteria and if bacterial profiles predict intervention response.

Design Sixty-seven patients with IBS were randomised to traditional IBS (n=34) or low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) (n=33) diets for 4 weeks. Food intake was recorded for 4 days during screening and intervention. Faecal samples and IBS Symptom Severity Score (IBS-SSS) reports were collected before (baseline) and after intervention. A faecal microbiota dysbiosis test (GA-map Dysbiosis Test) evaluated bacterial composition. Per protocol analysis was performed on 61 patients from whom microbiome data were available.

Results Responders (reduced IBS-SSS by ≥50) to low FODMAP, but not traditional, dietary intervention were discriminated from non-responders before and after intervention based on faecal bacterial profiles. Bacterial abundance tended to be higher in non-responders to a low FODMAP diet compared with responders before and after intervention. A low FODMAP intervention was associated with an increase in Dysbiosis Index (DI) scores in 42% of patients; while decreased DI scores were recorded in 33% of patients following a traditional IBS diet. Non-responders to a low FODMAP diet, but not a traditional IBS diet had higher DI scores than responders at baseline. Finally, while a traditional IBS diet was not associated with significant reduction of investigated bacteria, a low FODMAP diet was associated with reduced Bifidobacterium and Actinobacteria in patients, correlating with lactose consumption.

Conclusions A low FODMAP, but not a traditional IBS diet may have significant impact on faecal bacteria. Responsiveness to a low FODMAP diet intervention may be predicted by faecal bacterial profiles.

Trial registration number NCT02107625.

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Footnotes

  • Contributors SB: data acquisition, assemblage of database, interpretation of data and drafting and finalising of manuscript. Has approved the final draft submitted. LB: assemblage of database. Has approved the final draft submitted. HT: collection of study subject materials, interpretation of data and finalising of manuscript. Has approved the final draft submitted. SS, TL and LC: data acquisition. Have approved the final draft submitted. PL and HT: data acquisition and manuscript finalisation. Has approved the final draft submitted. LÖ: project planning, interpretation of data, drafting and finalising of manuscript. Has approved the final draft submitted. MS: project planning, interpretation of data, material acquisition, drafting and finalising of manuscript. Has approved the final draft submitted.

  • Funding The Swedish Medical Research Council (grants 13409, 21691 and 21692); AFA insurance (140330); VINNOVA (11-03475); The Marianne and Marcus Wallenberg Foundation, University of Gothenburg; Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg; The Faculty of Medicine, University of Gothenburg.

  • Competing interests MS has received unrestricted research grants from Danone, and Ferring Pharmaceuticals and served as a Consultant/Advisory Board member for AstraZeneca, Danone, Nestlé, Chr Hansen, Almirall, Allergan, Albireo, Glycom and Shire, and as a speaker for Tillotts, Takeda, Menarini, Allergan, Shire and Almirall. HT has served as Consultant/Advisory Board member for Almirall, Allergan, Danone and Shire. LÖ has served as Consultant/Advisory Board member for Genetic Analysis, has received unrestricted research grants from AstraZeneca, and as a speaker for Takeda, AbbVie and Meda. PL has served as Consultant/Advisory Board member for Almirall, Allergan, Abbvie and Shire.

  • Ethics approval The regional ethics board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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