Mediterranean diet intervention in overweight and obese subjects lowers plasma cholesterol and causes changes in the gut microbiome and metabolome independently of energy intake
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Objectives This study aimed to explore the effects of an isocaloric Mediterranean diet (MD) intervention on metabolic health, gut microbiome and systemic metabolome in subjects with lifestyle risk factors for metabolic disease. Design Eighty-two healthy overweight and obese subjects with a habitually low intake of fruit and vegetables and a sedentary lifestyle participated in a parallel 8-week randomised controlled trial. Forty-three participants consumed an MD tailored to their habitual energy intakes (MedD), and 39 maintained their regular diets (ConD). Dietary adherence, metabolic parameters, gut microbiome and systemic metabolome were monitored over the study period. Results Increased MD adherence in the MedD group successfully reprogrammed subjects’ intake of fibre and animal proteins. Compliance was confirmed by lowered levels of carnitine in plasma and urine. Significant reductions in plasma cholesterol (primary outcome) and faecal bile acids occurred in the MedD compared with the ConD group. Shotgun metagenomics showed gut microbiome changes that reflected individual MD adherence and increase in gene richness in participants who reduced systemic inflammation over the intervention. The MD intervention led to increased levels of the fibre-degrading Faecalibacterium prausnitzii and of genes for microbial carbohydrate degradation linked to butyrate metabolism. The dietary changes in the MedD group led to increased urinary urolithins, faecal bile acid degradation and insulin sensitivity that co-varied with specific microbial taxa. Conclusion Switching subjects to an MD while maintaining their energy intake reduced their blood cholesterol and caused multiple changes in their microbiome and metabolome that are relevant in future strategies for the improvement of metabolic health.
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Greater microbial diversity and higher abundance of health-promoting bacterial taxa are associated with consumption of the Mediterranean diet.
“Greater microbial diversity as well as higher abundance of health-promoting bacterial taxa (i.e., Clostridium cluster XIVa, F. prausnitzii, Roseburia, Eubacterium, B. thetaiotaomicron, Parabacteroides distasonis, Bifidobacterium adolescentis, and Bifidobacterium longum) have been associated with consumption of the Mediterranean diet (38)(39)(40).”
From Diet and the Microbiota–Gut–Brain Axis: Sowing the Seeds of Good Mental Health (2021) · cites this paper as [40]
More recent human intervention studies support a beneficial impact of a Mediterranean diet on microbiota profiles.
“More recent human intervention studies also support the beneficial impact of a Mediterranean diet on microbiota profiles.”
From Diet and the Microbiota–Gut–Brain Axis: Sowing the Seeds of Good Mental Health (2021) · cites this paper as [40]
Adherence to a Mediterranean diet is linked to beneficial microbiota-related metabolomic profiles, such as increased SCFAs and reductions in BCFAs, bile acids, and TMAO.
“Additionally, adherence to a Mediterranean diet was linked to beneficial microbiota-related metabolomic profiles, such as increased levels of SCFAs and reductions in BCFAs, bile acids, and trimethylamine N-oxide (TMAO) (38,40,41).”
From Diet and the Microbiota–Gut–Brain Axis: Sowing the Seeds of Good Mental Health (2021) · cites this paper as [40]
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- Authors
- Meslier, V., Laiola, M., Roager, H. M., De Filippis, F., Roume, H., Quinquis, B., Giacco, R., Mennella, I., Ferracane, R., Pons, N., Pasolli, E., Rivellese, A., Dragsted, L. O., Vitaglione, P., Ehrlich, S. D., & Ercolini, D.
- Affiliations
- Université Paris-Saclay (FR)
- University of Naples Federico II (IT)
- University of Copenhagen (DK)
- Department of Agricultural Sciences, University of Naples Federico II, Portici, Italy
- Université Paris-Saclay, INRAE, MGP, Jouy-en-Josas, France
- Institute of Food Science (IT)
- Federico II University Hospital (IT)
- Corresponding author
- Ercolini, Danilo
- ORCID
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2020-02-19
- Volume
- 69
- Issue
- 7
- Pages
- 1258-1268
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC7306983
- OpenAlex
- W3007138124
- Cited by
- 583
- References
- 69
- Citations by year
- 2026: 67 · 2025: 116 · 2024: 118 · 2023: 87 · 2022: 85 · 2021: 73 · 2020: 36 · 2018: 1
- FWCI
- 23.17
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Gut (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by-nc)
- HighWire Press Open Archive (submittedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, cc-by-nc)
- Funders
- Agence Nationale de la Recherche (ANR-11-DPBS-0001, ANR-15-HDIM-0002)
- Agria Djurförsäkring
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Nutrition, Genetics, and Disease
- Keywords
- Mediterranean diet, overweight, obesity, serum cholesterol, gut microbiota, metabolome, isocaloric diet, dietary adherence, Faecalibacterium prausnitzii, butyrate metabolism, bile acids, urolithins, insulin sensitivity, systemic inflammation, dietary fiber, L-carnitine, metabolic health
- MeSH terms
- Gastrointestinal Microbiome, Adult, Energy Intake, Cholesterol, Female, Humans, Male, Obesity, Diet, Mediterranean, Overweight, Metabolome
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