Diet and gut microbial associations in irritable bowel syndrome according to disease subtype

Gut Microbes. 2023 Dec;15(2):2262130. doi: 10.1080/19490976.2023.2262130.Epub 2023 Oct 2.


Yiqing Wang 1 2Wenjie Ma 1 2Raaj Mehta 1 2Long H Nguyen 1 2 3Mingyang Song 1 2 4 5David A Drew 1 2Francesco Asnicar 6Curtis Huttenhower 3 7Nicola Segata 6 8Jonathan Wolf 9Tim Spector 10Sarah Berry 11Kyle Staller 1 2Andrew T Chan 1 2 5 12


Author information

1Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

2Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

3Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

4Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

5Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA.

6Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy.

7Broad Institute of MIT and Harvard, Cambridge, MA, USA.

8European Institute of Oncology Scientific Institute for Research, Hospitalization and Healthcare, Milan, Italy.

9Zoe Ltd, London, UK.

10Department of Twin Research, King's College London, London, UK.

11Department of Nutritional Sciences, King's College London, London, UK.

12Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA.


The role of diet and the gut microbiome in the etiopathogenesis of irritable bowel syndrome (IBS) is not fully understood. Therefore, we investigated the interplay between dietary risk factors and gut microbiota in IBS subtypes using a food frequency questionnaire and stool metagenome data from 969 participants aged 18-65 years in the ZOE PREDICT 1 study, an intervention study designed to predict postprandial metabolic responses. We identified individuals with IBS subtype according to the Rome III criteria based on predominant bowel habits during symptom onset: diarrhea (i.e. looser), constipation (i.e. harder), and mixed. Participants with IBS-D (n = 59) consumed more healthy plant-based foods (e.g. whole grains, leafy vegetables) and fiber, while those with IBS-C (n= 49) tended to consume more unhealthy plant-based foods (e.g. refined grains, fruit juice) than participants without IBS (n = 797). Microbial diversity was nominally lower in patients with IBS-D than in participants without IBS or with IBS-C. Using multivariable-adjusted linear regression, we identified specific microbiota variations in IBS subtypes, including slight increases in pro-inflammatory taxa in IBS-C (e.g. Escherichia coli) and loss of strict anaerobes in IBS-D (e.g. Faecalibacterium prausnitzii). Our analysis also revealed intriguing evidence of interactions between diet and Faecalibacterium prausnitzii. The positive associations between fiber and iron intake and IBS-diarrhea were stronger among individuals with a higher relative abundance of Faecalibacterium prausnitzii, potentially driven by carbohydrate metabolic pathways, including the superpathway of β-D-glucuronide and D-glucuronate degradation. In conclusion, our findings suggest subtype-specific variations in dietary habits, gut microbial composition and function, and diet-microbiota interactions in IBS, providing insights into potential microbiome-informed dietary interventions.

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