Abstract

BackgroundFaecal dysbiosis associated with the use of metformin has been conceived as a favourable (“good”) dysbiosis and that with intake of non-nutritive sweeteners (NNS) as unfavourable (“bad”). The study aimed to construct an alternative dysbiosis index (ADI) for the separation of the dysbioses into “good” and “bad”, and to validate the ADI.MethodsSubjects with morbid obesity were included. Use of NNS and drugs were noted, IBS was classified according to the Rome III criteria and the severity measured with the Irritable bowel severity scoring system (IBSSS). Faecal dysbiosis was tested with GA-Map ™ Dysbiosis test (Genetic Analysis AS, Oslo, Norway). The result was given as Dysbiosis Index (DI) scores 1–5, score > 2 indicates dysbiosis. An ADI was constructed and validated in subjects with IBS at another hospital.ResultsSeventy-six women and 14 men aged 44.7 years (SD 8.6) with BMI 41.8 kg/m2 (SD 3.6) were included. Dysbiosis was associated with the use of NNS and metformin, but not with IBS or IBSSS. An ADI based on differences in 7 bacteria was positively and negatively associated with the “good” metformin dysbiosis and the “bad” NNS dysbiosis respectively. The ADI was also negatively associated with IBSSS (a “bad” dysbiosis). The negative associations between ADI and IBS and IBSS were confirmed in the validation group.ConclusionsThe new ADI, but not the DI, allowed separation of the “good” and “bad” faecal dysbiosis. Rather than merely reporting dysbiosis and degrees of dysbiosis, future diagnostic tests should distinguish between types of dysbiosis.

Highlights

  • Faecal dysbiosis associated with the use of metformin has been conceived as a favourable (“good”) dysbiosis and that with intake of non-nutritive sweeteners (NNS) as unfavourable (“bad”)

  • The main finding was the associations between dysbiosis and diabetes, metformin and NNS

  • A commercially available test for faecal dysbiosis showed a high prevalence of dysbiosis in subjects with morbid obesity, in users of metformin and NNS, but no association with gastrointestinal complaints

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Summary

Introduction

Faecal dysbiosis associated with the use of metformin has been conceived as a favourable (“good”) dysbiosis and that with intake of non-nutritive sweeteners (NNS) as unfavourable (“bad”). Gut dysbiosis, defined as an imbalance or deviation from the normal composition of the microbiota, might be either beneficial (good) due to improved immune system, increased anti/pro inflammatory. Both the diet and drugs influence the faecal microbiota [4,5,6,7]. Metformin has anti-hyperglycemic and weight-reducing effects, which are beneficial in subjects with obesity [8,9,10]. The metformin-induced dysbiosis, contributes to the therapeutic effects and is referred to as “good” dysbiosis.

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