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Gut Microbial Predictors of Type 2 Diabetes Remission Following Bariatric Surgery

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Abstract

Purpose

Distinct anatomical rearrangements of the gastrointestinal tract achieved by various types of bariatric surgery cause changes in nutrient intake and gut microbiota. The contribution of such gut microbiota changes to remission of type 2 diabetes (T2D) remains unclear.

Aim

We examined gut microbiota changes following banded Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in a randomised study, in relation to T2D remission.

Materials and Methods

Whole-metagenome shotgun sequencing was carried out on paired stool samples at pre- and 1-year post-surgery collected from 44 participants with T2D randomised to banded Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Taxonomic composition and predicted functional potential of the gut bacteria were identified using HUMANn2, and annotated using MetaCyc. Five-day dietary records (analysed using FoodWorks v8.0), body weight and diabetes status were recorded at both time points.

Results

RYGB participants had higher percentage excess weight loss than SG (p = 0.01), even though dietary intake was similar at 1-year post-surgery. Similar proportions achieved diabetes remission (HbA1c < 48 mmol/mol without medications) after either RYGB (68%) or SG (59%). RYGB resulted in increased abundances of Firmicutes and Proteobacteria, while SG resulted in increased Bacteroidetes. Pre-surgery, an increased abundance of Eubacteriaceae (p = 0.01) and Alistipes putredinis (p = 0.01) was observed in those who went on to remit from T2D post-surgery. Following surgery, Lachnospiraceae (p = 0.04) and Roseburia (p = 0.01) species were more abundant in those who had achieved T2D remission.

Conclusions

Specific stool bacterial taxa may signal likelihood of T2D remission after bariatric surgery which is potentially mediated by increases in Lachnospiraceae and Roseburia.

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Abbreviations

ANOVA:

Analysis of variance

BMI:

Body mass index

GI:

Gastrointestinal

LDA:

Linear discriminant analysis

LEfSe:

Linear discriminant analysis effect size

PERMANOVA:

Permutational multivariate analysis of variance

RCT:

Randomised controlled trial

RYGB:

Roux-en-Y gastric bypass

SCFA:

Short chain fatty acids

SG:

Sleeve gastrectomy

T2D:

Type 2 diabetes

VLCD:

Very low calorie diet

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Acknowledgements

We would like to acknowledge the following people for their generous contribution to this trial and manuscript: Michael Booth, Bronwen Jones, Hisham Hammodat and Michael G. Clarke.

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Correspondence to Rinki Murphy.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Davies, N., O’Sullivan, J.M., Plank, L.D. et al. Gut Microbial Predictors of Type 2 Diabetes Remission Following Bariatric Surgery. OBES SURG 30, 3536–3548 (2020). https://doi.org/10.1007/s11695-020-04684-0

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