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Adjusting for age improves identification of gut microbiome alterations in multiple diseases
Open accessAbstract
Interaction between disease-microbiome associations and ageing has not been explored in detail. Here, using age/region-matched sub-sets, we analysed the gut microbiome differences across five major diseases in a multi-cohort dataset constituting more than 2500 individuals from 20 to 89 years old. We show that disease-microbiome associations display specific age-centric trends. Ageing-associated microbiome alterations towards a disease-like configuration occur in colorectal cancer patients, thereby masking disease signatures. We identified a microbiome disease response shared across multiple diseases in elderly subjects that is distinct from that in young/middle-aged individuals, but also a novel set of taxa consistently gained in disease across all age groups. A subset of these taxa was associated with increased frailty in subjects from the ELDERMET cohort. The relevant taxa differentially encode specific functions that are known to have disease associations.
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“Members of the Bifidobacteriaceae, Akkermansiaceae, and Eubacteriaceae families that are associated with beneficial effects on intestinal and extra-intestinal health in both mice and humans”
From Fecal microbiota transfer between young and aged mice reverses hallmarks of the aging gut, eye, and brain (2022) · cites this paper as [43]
In the citing paper
“However, some species are currently thought to modulate cholesterol and bile acid metabolism and are considered potential therapeutics [43].”
From Fecal microbiota transfer between young and aged mice reverses hallmarks of the aging gut, eye, and brain (2022) · cites this paper as [43]
In the citing paper
“Age was also added to the feature-set, as this covariate has been shown to improve microbiome predictions in CRC (Ghosh et al., 2020).”
From Integrating taxonomic, functional, and strain-level profiling of diverse microbial communities with bioBakery 3 (2021) · cites this paper as Ghosh et al., 2020
In the citing paper
“The Enterocloster genus (E. aldensis, E. asparagiformis, and E. bolteae) represents a vancomycin-sensitive clade of immunosuppressive bacteria, dominant in the intestinal microbiota of people and patients suffering from aging and chronic inflammatory disorders including cancer.39”
From Custom scoring based on ecological topology of gut microbiota associated with cancer immunotherapy outcome (2024) · cites this paper as [47]
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Citations
Cites
A metagenome-wide association study of gut microbiota in type 2 diabetes
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BackgroundMethodResultInfluentialGut microbiota composition correlates with diet and health in the elderly
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ResultSelf-citationGut metagenome in European women with normal, impaired and diabetic glucose control
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MethodResultDisentangling type 2 diabetes and metformin treatment signatures in the human gut microbiota
MetaHIT consortium, Forslund, K., Hildebrand, F., Nielsen, T., Falony, G., Le Chatelier, E., Sunagawa, S., Prifti, E., Vieira-Silva, S., Gudmundsdottir, V., et al. (2015) · Nature · doi:10.1038/nature15766 · Cited by 2,116 · cited 4×
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“not CRC), we compiled a list of known disease-associated markers from each of the original studies (Feng et al., 2015; Franzosa et al., 2019; Karlsson et al., 2013; Qin et al., 2012; Qin et al., 2014).”
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BackgroundInfluentialGut microbiota development across the lifespan: Disease links and health‐promoting interventions
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Microbiome and health implications for ethnic minorities after enforced lifestyle changes
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“This observation supports previous research linking these species to unhealthy aging phenotypes, including frailty 43,47 .”
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Lian, W., Wang, F., Chen, Y., Tsai, M., Chao, H., Jahr, H., Wu, R., & Ko, J. (2022) · Biomedicines · doi:10.3390/biomedicines10040860 · Cited by 46
A gut aging clock using microbiome multi-view profiles is associated with health and frail risk
Wang, H., Chen, Y., Feng, L., Lu, S., Zhu, J., Zhao, J., Zhang, H., Chen, W., & Lu, W. (2024) · Gut Microbes · doi:10.1080/19490976.2023.2297852 · Cited by 45
“15 Specifically, validation samples were downloaded from the NCBI sequence data and annotated according to the following method.”
MethodThe role of the microbiota in glaucoma
Huang, L., Hong, Y., Fu, X., Tan, H., Chen, Y., Wang, Y., & Chen, D. (2023) · Molecular Aspects of Medicine · doi:10.1016/j.mam.2023.101221 · Cited by 49
Almeida, H. M., Sardeli, A. V., Conway, J., Duggal, N. A., & Cavaglieri, C. R. (2022) · Ageing Research Reviews · doi:10.1016/j.arr.2022.101773 · Cited by 47
Gut Microbiome Interactions with Oxidative Stress: Mechanisms and Consequences for Health
Semenova, N. V., Garashchenko, N. E., Kolesnikov, S. I., Darenskaya, M. A., & Kolesnikova, L. (2024) · Pathophysiology · doi:10.3390/pathophysiology31030023 · Cited by 47
“The gut microbiome structure is affected by a variety of factors, including the environment, diet, age, and geographical location [2–6].”
BackgroundTierney, B. T., Tan, Y., Yang, Z., Shui, B., Walker, M. J., Kent, B. M., Kostic, A. D., & Patel, C. J. (2022) · PLoS Biology · doi:10.1371/journal.pbio.3001556 · Cited by 41
Early-onset Colon Cancer Shows a Distinct Intestinal Microbiome and a Host–Microbe Interaction
Adnan, D., Trinh, J. Q., Sharma, D., Alsayid, M., & Bishehsari, F. (2023) · Cancer Prevention Research · doi:10.1158/1940-6207.capr-23-0091 · Cited by 44
Abdullah, M., Sukartini, N., Nursyirwan, S. A., Pribadi, R. R., Maulahela, H., Utari, A. P., Muzellina, V. N., Wiraatmadja, A., & Renaldi, K. (2021) · Digestion · doi:10.1159/000516689 · Cited by 43
Zhu, L., Chen, J., Pi, X., Li, J., Liu, W., Ding, Q., Wang, X., & Jia, W. (2021) · BMC Microbiology · doi:10.1186/s12866-021-02103-7 · Cited by 40
“We refer midlife as the people between 40 to 60 years old.[33, 34]”
MethodHuman microbiome variance is underestimated
Shanahan, F., Ghosh, T. S., & O’Toole, P. W. (2023) · Current Opinion in Microbiology · doi:10.1016/j.mib.2023.102288 · Cited by 43
Self-citationInfluence of human gut microbiome on the healthy and the neurodegenerative aging
Borrego-Ruiz, A., & Borrego, J. J. (2024) · Experimental Gerontology · doi:10.1016/j.exger.2024.112497 · Cited by 43
Zhang, X., Zhao, A., Sandhu, A. K., Edirisinghe, I., & Burton‐Freeman, B. M. (2020) · Nutrients · doi:10.3390/nu12113595 · Cited by 40
“suggested that younger people gain disease-causing microbes, whereas in older cohorts, the loss of beneficial bacteria may associate with disease [39].”
BackgroundResultInfluentialConvergent pathways of the gut microbiota–brain axis and neurodegenerative disorders
Gubert, C., Gasparotto, J., & Morais, L. H. (2022) · Gastroenterology report · doi:10.1093/gastro/goac017 · Cited by 40
“Taken together, these studies demonstrate that diet and disease status are important co-variates for aging-linked microbiota associations [120].”
Toward a health-associated core keystone index for the human gut microbiome
Goel, A., Shete, O., Goswami, S., Samal, A., C.B., L., Kedia, S., Ahuja, V., O’Toole, P. W., Shanahan, F., & Ghosh, T. S. (2025) · Cell Reports · doi:10.1016/j.celrep.2025.115378 · Cited by 37
Self-citationThe role of dietary strategies in the modulation of hallmarks of aging
de França, N. A. G., Rolland, Y., Guyonnet, S., & Barreto, P. D. S. (2023) · Ageing Research Reviews · doi:10.1016/j.arr.2023.101908 · Cited by 41
Gut Microbiota and Aging: Traditional Chinese Medicine and Modern Medicine
Li, J., Li, D., Chen, Y., Chen, W., Xu, J., & Gao, L. (2023) · Clinical Interventions in Aging · doi:10.2147/cia.s414714 · Cited by 37
“Therefore, it is a significant challenge to clarify the relative contribution of age, drugs, diet and comorbidity to microbial dysbiosis.(60) Indeed, research on the elderly adjusted for diet, lifestyle and medication shows that age is a critical factor in the increase or decrease of the microbial species in the gut,(…”
Sadoughi, B., Schneider, D., Daniel, R., Schülke, O., & Ostner, J. (2022) · Microbiome · doi:10.1186/s40168-022-01283-2 · Cited by 37
“Disentangling the effect of age and frailty is complicated by their strong covariation because age-related changes in diet, medication, lifestyle, location, and concomitant diseases typically correlate [9, 23, 29, 31].”
BackgroundInfluentialFleischer, R., Schmid, D. W., Wasimuddin, Brändel, S. D., Rasche, A., Corman, V. M., Drosten, C., Tschapka, M., & Sommer, S. (2022) · Molecular Ecology · doi:10.1111/mec.16491 · Cited by 35
“Collectively, these results indicate age- specific MHC– microbiota relationships and altered immunomodulatory function of an ageing microbiome (Ghosh et al., 2020).”
BackgroundYou, X., Dadwal, U. C., Lenburg, M. E., Kacena, M. A., & Charles, J. F. (2022) · mSystems · doi:10.1128/msystems.01248-21 · Cited by 36
“For example, diet, medication, disease status, and duration of stay in a care facility may all impact the aging microbiome, yet data on these factors are frequently lacking in human aging microbiome research (15, 46).”
BackgroundDucloux, D., Legendre, M., Bamoulid, J., Saas, P., Courivaud, C., & Crépin, T. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2021.720402 · Cited by 38
Bidirectional relationships between the gut microbiome and sexual traits
del Castillo-Izquierdo, Á., Mayneris‐Perxachs, J., & Fernández‐Real, J. M. (2022) · American Journal of Physiology-Cell Physiology · doi:10.1152/ajpcell.00116.2022 · Cited by 35
“As Fusobacterium relative abundance also increases with age (Ghosh et al, 2020; Shanahan et al, 2021), gender-specific differences seem to confluence with age-specific changes leading to differential gender-specific susceptibility to a given disease.”
Zhuang, Y.-P., Zhou, H., Chen, H., Zheng, M.-Y., Liang, Y., Gu, Y.-T., Li, W., Qiu, W., & Zhou, H. (2023) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2023.115040 · Cited by 34
Ravikrishnan, A., Wijaya, I., Png, E., Chng, K. R., Ho, E. X. P., Ng, A. H. Q., Naim, A. N. M., Gounot, J.-S., Guan, S. P., Lee, J. H., et al. (2024) · Nature Communications · doi:10.1038/s41467-024-52097-9 · Cited by 39
“Several studies have also highlighted that frailty indices and healthy aging are linked to the state of the gut microbiome 16,17 , along with known gut-microbiome associations with aging-related diseases 18,19 .”
BackgroundMethodRooney, C. M., Jeffery, I. B., Mankia, K. S., Wilcox, M. H., & Emery, P. (2024) · Annals of the Rheumatic Diseases · doi:10.1136/ard-2024-226362 · Cited by 36
“Due to the observed decrease in alpha diversity preceding RA onset (see online supplemental materials, page 44), pairwise dissimilarities between timepoints were assessed to examine gut microbiome stability using 16S rRNA amplicon sequencing.”
Self-citationType, Intensity, and Duration of Exercise as Regulator of Gut Microbiome Profile
Suryani, D., Alfaqih, M. S., Gunadi, J. W., Sylviana, N., Goenawan, H., Megantara, I., & Lesmana, R. (2022) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000940 · Cited by 34
Carr, R. M., Li, Y., Chau, L., Friedman, E. S., Lee, J., Adorini, L., Erickson, M., Zaru, L., Shringarpure, R., MacConell, L., et al. (2023) · Hepatology · doi:10.1097/hep.0000000000000474 · Cited by 34
“Together with prior studies showing an association between gut microbiome composition, BMI, [42] and age, [45] these results provide additional evidence emphasizing the critical need to control for both BMI and age when investigating the role of the gut microbiome in NASH.”
ResultAraújo, J. R., Marques, C., Rodrigues, C., Calhau, C., & Faria, A. (2024) · Ageing Research Reviews · doi:10.1016/j.arr.2024.102451 · Cited by 32
Epigenetic Mechanisms in Aging: Extrinsic Factors and Gut Microbiome
Borrego-Ruiz, A., & Borrego, J. J. (2024) · Genes · doi:10.3390/genes15121599 · Cited by 34
“Table 3 shows the GM dysbiosis related to unhealthy aging due to several disorders (modified from [295,318–324]).”
Age-Related Cognitive Decline and Dementia: Interface of Microbiome–Immune–Neuronal Interactions
Prajapati, S. K., Jain, S., & Yadav, H. (2025) · The Journals of Gerontology Series A · doi:10.1093/gerona/glaf038 · Cited by 37
Lapauw, L., Rutten, A., Dupont, J., Amini, N., Vercauteren, L., Derrien, M., Raes, J., & Gielen, E. (2024) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.13569 · Cited by 28
A metagenomic study of gut viral markers in amyloid-positive Alzheimer’s disease patients
Ghorbani, M., Ferreira, D., & Maioli, S. (2023) · Alzheimer s Research & Therapy · doi:10.1186/s13195-023-01285-8 · Cited by 29
Obesity is the main driver of altered gut microbiome functions in the metabolically unhealthy
de la Cuesta‐Zuluaga, J., Huus, K. E., Youngblut, N. D., Escobar, J. S., & Ley, R. E. (2023) · Gut Microbes · doi:10.1080/19490976.2023.2246634 · Cited by 27
“57,58 In other words, accounting for common confounders might facilitate the comparison between studies by ameliorating biases introduced by the confounding variables.”
BackgroundGut microbiota–astrocyte axis: new insights into age-related cognitive decline
Zhang, L., Wei, J., Liu, X., Li, D., Pang, X., Chen, F., Cao, H., & Lei, P. (2024) · Neural Regeneration Research · doi:10.4103/nrr.nrr-d-23-01776 · Cited by 28
“Among these metabolites, p-cresol has been demonstrated to be correlated with increased frailty and is linked to age-associated decline in elderly individuals (Ghosh et al., 2020).”
BackgroundUtilization of Host and Microbiome Features in Determination of Biological Aging
Ratiner, K., Abdeen, S. K., Goldenberg, K., & Elinav, E. (2022) · Microorganisms · doi:10.3390/microorganisms10030668 · Cited by 27
Exploring the Gut Microbiota–Retina Axis: Implications for Health and Disease
Schiavone, N., Isoldi, G., Calcagno, S., Rovida, E., Antiga, E., Almeida, C. V. D., & Lulli, M. (2025) · Microorganisms · doi:10.3390/microorganisms13051101 · Cited by 27
“The human gut microbial community plays a fundamental role in maintaining physiological homeostasis, yet its composition and function are subject to modifications over time [14].”
Manghi, P., Antonello, G., Schiffer, L., Golzato, D., Wokaty, A., Beghini, F., Mirzayi, C. A., Long, K., Gravel-Pucillo, K., Piccinno, G., et al. (2025) · Nature Communications · doi:10.1038/s41467-025-66888-1 · Cited by 26
“Different con fi gurations of the gut microbiome associated with sex have been reported 2,4,5,13,43 , but these studies have been limited in population diversity and standardized metadata.”
Cross‐Cohort Gut Microbiome Signatures of Irritable Bowel Syndrome Presentation and Treatment
Li, J., Ghosh, T. S., Arendt, E. K., Shanahan, F., & O’Toole, P. W. (2024) · Advanced Science · doi:10.1002/advs.202308313 · Cited by 25
Self-citationKrüger, K., Myeonghyun, Y., van der Wielen, N., Kok, D. E. G., Hooiveld, G. J. E. J., Keshtkar, S., Bruin, M. D.-D., Balvers, M. G. J., Grootte-Bromhaar, M., Mudde, K., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-75477-z · Cited by 27
Gut Microbiota–Related Biomarkers in Immuno-Oncology
Silva, C. A. C., Fidelle, M., Almonte, A. A., Derosa, L., & Zitvogel, L. (2025) · Annual Review of Pharmacology and Toxicology · doi:10.1146/annurev-pharmtox-061124-102218 · Cited by 22
The gut microbiome and ageing trajectories: mechanisms and clinical implications
Ticinesi, A., Maggi, S., Nouvenne, A., Zuliani, G., & Franceschi, C. (2026) · Nature Reviews Endocrinology · doi:10.1038/s41574-026-01236-x · Cited by 25
“The biological process of ageing, however, shapes gut microbiome composition beyond the sum of the influences of lifetime exposures, inducing changes that tend to dysbiosis 65 .”
Scarring the early-life microbiome: its potential life-long effects on human health and diseases
Park, H., Park, N.-Y., & Koh, A. (2023) · BMB Reports · doi:10.5483/bmbrep.2023-0114 · Cited by 27
“microbiome analysis results given that age-specific differences have been observed in gut microbial change-related diseases among individuals aged 20 to 89 years (13).”
BackgroundThe effect of exercise on depression and gut microbiota: Possible mechanisms
Yao, M., Qu, Y., Zheng, Y., & Guo, H. (2024) · Brain Research Bulletin · doi:10.1016/j.brainresbull.2024.111130 · Cited by 26
“Gut microbiota plays a pivotal role in upholding gut homeostasis but it is susceptible to both internal and external factors, including gene, dietary habits, exercise, and illnesses (Power et al., 2014; Ghosh et al., 2020; O ’ Sullivan et al., 2015).”
Discovering geroprotectors through the explainable artificial intelligence-based platform AgeXtend
Arora, S., Mittal, A., Duari, S., Chauhan, S., Dixit, N. K., Mohanty, S. K., Sharma, A., Solanki, S., Sharma, A. K., Gautam, V., et al. (2024) · Nature Aging · doi:10.1038/s43587-024-00763-4 · Cited by 22
“We began by investigating each taxon and its species associations Technical Report https://doi.org/10.1038/s43587-024-00763-4 with the functional independence measure (FIM) from the ELDERMET gut microbiome cohort study (http://eldermet.ucc.ie) 40 .”
InfluentialSelf-citationMicrobial–Immune Crosstalk in Elderly-Onset Inflammatory Bowel Disease: Unchartered Territory
Meng, G., Monaghan, T. M., Duggal, N. A., Tighe, P., & Peerani, F. (2023) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjad025 · Cited by 21
Postbiotics: A Promising Approach to Combat Age-Related Diseases
Hamdi, A., Lloyd, C., Eri, R. D., & Van, T. T. H. (2025) · Life · doi:10.3390/life15081190 · Cited by 25
“The authors reported a marked increase in Muribaculaceae spp., Bacteroidales bacterium M9 , Bacteroidales bacterium M10 , and A. muciniphila , while observing negative correlations with E. coli , Bacteroides intestinalis, and Helicobacter bilis in the postbiotic-fed mice groups.”
Metadata
- Authors
- Ghosh, T. S., Das, M., Jeffery, I. B., & O'Toole, P. W.
- Affiliations
- University College Cork (IE)
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Venue
- eLife
- Publisher
- eLife Sciences Publications, Ltd
- Published
- 2020-03-11
- Volume
- 9
- ISSN
- 2050-084X (ISSN-L)
- PMC
- PMC7065848
- OpenAlex
- W3011436618
- Cited by
- 233
- References
- 45
- Citations by year
- 2026: 30 · 2025: 29 · 2024: 56 · 2023: 38 · 2022: 37 · 2021: 23 · 2020: 20
- FWCI
- 9.65
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- eLife (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion)
- Funders
- Science Foundation Ireland (APC/SFI/12/RC/2273, 13/SIRG/2128)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- gut microbiota, aging, age adjustment, colorectal cancer, frailty, multi-cohort analysis
- MeSH terms
- Gastrointestinal Microbiome, Adult, Age Factors, Aged, Aged, 80 and over, Data Interpretation, Statistical, Disease Susceptibility, Female, Humans, Male, Middle Aged, Reproducibility of Results, Computational Biology, Metagenome, Young Adult, Metagenomics, Microbiota, Dysbiosis
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