Faecal and urine metabolites, but not gut microbiota, may predict response to low FODMAP diet in irritable bowel syndrome



Wilson, Bridgette, Kanno, Tokuwa, Slater, Rachael, Rossi, Megan, Irving, Peter M, Lomer, Miranda C, Probert, Chris ORCID: 0000-0003-0477-6714, Mason, A James and Whelan, Kevin
(2023) Faecal and urine metabolites, but not gut microbiota, may predict response to low FODMAP diet in irritable bowel syndrome. ALIMENTARY PHARMACOLOGY & THERAPEUTICS, 58 (4). pp. 404-416.

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Abstract

<h4>Background</h4>The low FODMAP diet (LFD) leads to clinical response in 50%-80% of patients with irritable bowel syndrome (IBS). It is unclear why only some patients respond.<h4>Aims</h4>To determine if differences in baseline faecal microbiota or faecal and urine metabolite profiles may separate clinical responders to the diet from non-responders allowing predictive algorithms to be proposed.<h4>Methods</h4>We recruited adults fulfilling Rome III criteria for IBS to a blinded randomised controlled trial. Patients were randomised to sham diet with a placebo supplement (control) or LFD supplemented with either placebo (LFD) or 1.8 g/d B-galactooligosaccharide (LFD/B-GOS), for 4 weeks. Clinical response was defined as adequate symptom relief at 4 weeks after the intervention (global symptom question). Differences between responders and non-responders in faecal microbiota (FISH, 16S rRNA sequencing) and faecal (gas-liquid chromatography, gas-chromatography mass-spectrometry) and urine (<sup>1</sup> H NMR) metabolites were analysed.<h4>Results</h4>At 4 weeks, clinical response differed across the 3groups with adequate symptom relief of 30% (7/23) in controls, 50% (11/22) in the LFD group and 67% (16/24) in the LFD/B-GOS group (p = 0.048). In the control and the LFD/B-GOS groups, microbiota and metabolites did not separate responders from non-responders. In the LFD group, higher baseline faecal propionate (sensitivity 91%, specificity 89%) and cyclohexanecarboxylic acid esters (sensitivity 80%, specificity 78%), and urine metabolite profile (Q<sup>2</sup> 0.296 vs. randomised -0.175) predicted clinical response.<h4>Conclusions</h4>Baseline faecal and urine metabolites may predict response to the LFD.

Item Type: Article
Uncontrolled Keywords: FODMAP, IBS, microbiota, prebiotics
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 25 Sep 2023 08:39
Last Modified: 25 Sep 2023 08:39
DOI: 10.1111/apt.17609
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3172984