Gastrointestinal tract involvement in systemic sclerosis : The roles of diet and the microbiome
(2023) In Seminars in Arthritis and Rheumatism 60.- Abstract
Background: Alterations in gastrointestinal (GI) microbial composition have been reported in patients with systemic sclerosis (SSc). However, it is unclear to what degree these alterations and/or dietary changes contribute to the SSc-GI phenotype. Objectives: Our study aimed to 1) evaluate the relationship between GI microbial composition and SSc-GI symptoms, and 2) compare GI symptoms and GI microbial composition between SSc patients adhering to a low versus non-low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet. Methods: Adult SSc patients were consecutively recruited to provide stool specimens for bacterial 16S rRNA gene sequencing. Patients completed the UCLA Scleroderma Clinical Trial... (More)
Background: Alterations in gastrointestinal (GI) microbial composition have been reported in patients with systemic sclerosis (SSc). However, it is unclear to what degree these alterations and/or dietary changes contribute to the SSc-GI phenotype. Objectives: Our study aimed to 1) evaluate the relationship between GI microbial composition and SSc-GI symptoms, and 2) compare GI symptoms and GI microbial composition between SSc patients adhering to a low versus non-low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet. Methods: Adult SSc patients were consecutively recruited to provide stool specimens for bacterial 16S rRNA gene sequencing. Patients completed the UCLA Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument (GIT 2.0) and the Diet History Questionnaire (DHQ) II and were classified as adhering to a low or non-low FODMAP diet. GI microbial differences were assessed using three metrics of alpha diversity (species richness, evenness, and phylogenetic diversity), as well as beta diversity (overall microbial composition). Differential abundance analysis was performed to identify specific genera associated with SSc-GI phenotype and low versus non-low FODMAP diet. Results: Of the 66 total SSc patients included, the majority were women (n = 56) with a mean disease duration of 9.6 years. Thirty-five participants completed the DHQ II. Increased severity of GI symptoms (total GIT 2.0 score) was associated with decreased species diversity and differences in GI microbial composition. Specifically, pathobiont genera (e.g., Klebsiella and Enterococcus) were significantly more abundant in patients with increased GI symptom severity. When comparing low (N = 19) versus non-low (N = 16) FODMAP groups, there were no significant differences in GI symptom severity or in alpha and beta diversity. Compared with the low FODMAP group, the non-low FODMAP group had greater abundance of the pathobiont Enterococcus. Conclusion: SSc patients reporting more severe GI symptoms exhibited GI microbial dysbiosis characterized by less species diversity and alterations in microbial composition. A low FODMAP diet was not associated with significant alterations in GI microbial composition or reduced SSc-GI symptoms; however, randomized controlled trials are needed to evaluate the impact of specific diets on GI symptoms in SSc.
(Less)
- author
- Nguyen, Audrey D. ; Andréasson, Kristofer LU ; McMahan, Zsuzsanna H. ; Bukiri, Heather ; Howlett, Natalie ; Lagishetty, Venu ; Lee, Sungeun Melanie ; Jacobs, Jonathan P. and Volkmann, Elizabeth R.
- organization
- publishing date
- 2023-06
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- FODMAP diet, Gastrointestinal microbiome, nutrition, Systemic sclerosis
- in
- Seminars in Arthritis and Rheumatism
- volume
- 60
- article number
- 152185
- publisher
- W.B. Saunders
- external identifiers
-
- pmid:36870237
- scopus:85149329592
- ISSN
- 0049-0172
- DOI
- 10.1016/j.semarthrit.2023.152185
- language
- English
- LU publication?
- yes
- id
- 94ebefd3-40cb-49dc-946d-b37b06a3460a
- date added to LUP
- 2024-01-12 14:28:08
- date last changed
- 2024-04-13 07:54:31
@article{94ebefd3-40cb-49dc-946d-b37b06a3460a,
abstract = {{<p>Background: Alterations in gastrointestinal (GI) microbial composition have been reported in patients with systemic sclerosis (SSc). However, it is unclear to what degree these alterations and/or dietary changes contribute to the SSc-GI phenotype. Objectives: Our study aimed to 1) evaluate the relationship between GI microbial composition and SSc-GI symptoms, and 2) compare GI symptoms and GI microbial composition between SSc patients adhering to a low versus non-low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet. Methods: Adult SSc patients were consecutively recruited to provide stool specimens for bacterial 16S rRNA gene sequencing. Patients completed the UCLA Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument (GIT 2.0) and the Diet History Questionnaire (DHQ) II and were classified as adhering to a low or non-low FODMAP diet. GI microbial differences were assessed using three metrics of alpha diversity (species richness, evenness, and phylogenetic diversity), as well as beta diversity (overall microbial composition). Differential abundance analysis was performed to identify specific genera associated with SSc-GI phenotype and low versus non-low FODMAP diet. Results: Of the 66 total SSc patients included, the majority were women (n = 56) with a mean disease duration of 9.6 years. Thirty-five participants completed the DHQ II. Increased severity of GI symptoms (total GIT 2.0 score) was associated with decreased species diversity and differences in GI microbial composition. Specifically, pathobiont genera (e.g., Klebsiella and Enterococcus) were significantly more abundant in patients with increased GI symptom severity. When comparing low (N = 19) versus non-low (N = 16) FODMAP groups, there were no significant differences in GI symptom severity or in alpha and beta diversity. Compared with the low FODMAP group, the non-low FODMAP group had greater abundance of the pathobiont Enterococcus. Conclusion: SSc patients reporting more severe GI symptoms exhibited GI microbial dysbiosis characterized by less species diversity and alterations in microbial composition. A low FODMAP diet was not associated with significant alterations in GI microbial composition or reduced SSc-GI symptoms; however, randomized controlled trials are needed to evaluate the impact of specific diets on GI symptoms in SSc.</p>}},
author = {{Nguyen, Audrey D. and Andréasson, Kristofer and McMahan, Zsuzsanna H. and Bukiri, Heather and Howlett, Natalie and Lagishetty, Venu and Lee, Sungeun Melanie and Jacobs, Jonathan P. and Volkmann, Elizabeth R.}},
issn = {{0049-0172}},
keywords = {{FODMAP diet; Gastrointestinal microbiome; nutrition; Systemic sclerosis}},
language = {{eng}},
publisher = {{W.B. Saunders}},
series = {{Seminars in Arthritis and Rheumatism}},
title = {{Gastrointestinal tract involvement in systemic sclerosis : The roles of diet and the microbiome}},
url = {{http://dx.doi.org/10.1016/j.semarthrit.2023.152185}},
doi = {{10.1016/j.semarthrit.2023.152185}},
volume = {{60}},
year = {{2023}},
}