4. Discussion
Personalized nutrition assumes that each person may have a different response to specific foods and nutrients and will benefit from individual concepts adapted to their health status and lifestyle factors. This concept also considers the microbiome and its influence on our metabolism. The human microbiota has numerous functions playing a pivotal role in health maintenance. It comprises all microbial taxa associated with human beings such as bacteria, viruses, fungi, protozoa, and archaea. It is assumed that 38 × 1012 (trillion) bacterial cells are harbored by each person [
21]. It is hypothesized that its composition is unique to everyone. In daily practice, the development and implementation of individual and personalized nutrition concepts is a great challenge.
One approach to addressing this problem may be the development of concepts for individuals with the common metabolism-influencing characteristics such as age, gender, physical activity, and diet. We have shown that diet has a strong impact on types of bacteria colonizing our digestive tracts [
22]. For example, consumption of the Mediterranean diet for one year by obese men (
n = 20) significantly decreased the genera Prevotella and increased Roseburia and Oscillospira [
23]. Roseburia is a known butyrate producer with immune maintenance and anti-inflammatory properties [
24]. Furthermore, the implementation of different long-term dietary patterns, such as plant-based diets vs. omnivorous diets, significantly influences our gut microbiota composition [
25]. The findings of the NuEva study support the idea that diet strongly influences microbiome composition. This is most evident in omnivores and vegans (
Figure 4 and
Figure 5).
The vegan diet has a lower energy value but is comparably rich in dietary fiber. The gut microbiota plays an important role in the fermentation of these non-digestible substrates to SCFAs, which are important signaling molecules [
9,
10]. Hence, it could be conceivably hypothesized that different intakes of dietary fibers have varying impacts on human gut microbiota. Following this hypothesis, Firmicutes (in order WD/Flex/VN/VG) such as Fecalibacterium (7.0/7.1/6.9/7.8%), Roseburia (2.0/2.0/2.5/3.3%), and Anaerostipes (2.8/3.0/2.5/2.9%), which are famous for producing butyrate, belong to the 10 most abundant genera for all diet forms (
Supplementary Figure S2). The abundance of two from these three is higher in vegans, indicating a higher production of butyrate. Moreover, the lowest abundance of Lachnospiraceae_1 and Lachnospiraceae UCG_004 was observed in the WD group and the highest abundance was seen in vegans (
Figure 4 and
Figure 5). The high abundance of Lachnospiraceae, a family of obligate anaerobic and variably spore-forming bacteria in the order Eubacteriales, in vegans points to high fermentation of plant-based polysaccharides to SCFAs such as butyrate, acetate, and alcohols [
26]. Butyrate is an important energy source for the cells of the gut lining. It has further health benefits such as its antioxidant properties that stimulate the production of glutathione, controlling intestinal inflammation and protecting against colon cancer in humans [
27,
28]. The higher abundance of Lachnospiraceae in vegans compared to omnivores was also reported by other groups [
29,
30].
However, the high abundance of Bacteroides detected in the vegan group contrasts with data from Wu et al. [
31] that described two diet-related enterotypes. The first enterotype dominated by Bacteroides is adapted to diets high in protein and animal fats, while the Prevotella enterotype is associated with carbohydrate metabolism and a vegetarian diet. Bacteroides are related to a more pro-inflammatory state and possibly related to the increased risk of the metabolic syndrome and further pathological conditions [
25]. In contrast, the systematic review of Losno et al. [
32] observed an increase in Bacteroidetes on the phylum level and a higher abundance of Prevotella on the genus level in vegans compared to omnivores. The higher abundance of Bacteroidetes in our data reflected Losno‘s findings [
32]. However, an increase of Prevotella in VG or VN was not evident in the NuEva collective (
Supplementary Figure S2). Furthermore, the review of Zafar and Saier [
33] showed that specific Bacteroides species primarily depend on adults’ dietary pattern. In general, Bacteroides species (spp.) are involved in the digestion of various polysaccharides [
34], provide protection from pathogens, and supply the host and other microbial cells with nutrients. Higher percentages of B. thetaiotaomicron, B. salyersiae, as well as B. vulgatus are found in vegetarians and vegans, whereas B. fragilis, B. salanitronis, and B. coprocola are more prevalent in omnivores. In our study, the most identified Bacteroides species were B. vulgatus (WD, 4.1%; Flex, 4.3%; VG, 6.0%; VN, 6.7%, on average), B. uniformis (WD, 2.6%; Flex, 3.2%; VG, 3.2%; VN, 3.0%), B. thetaiotaomicron (WD, 0.3%; Flex, 0.4%; VG, 0.5%; VN, 0.4%) and B. cellulosilyticus (WD, 0.2%; Flex, 0.6%; VG, 0.4%; VN, 0.4%).
In contrast, several studies to date reported higher abundance of Prevotella in vegans compared to omnivores [
29,
35,
36].
Previous research results on Bacteroides have been inconsistent and contradictory. Some recent studies have observed higher levels of Bacteroides in vegans [
35,
37], while others have reported a lower abundance of Bacteroides in vegans compared to omnivores [
35,
38].
Prevotella spp. Are associated with anti-inflammatory disorders, such as rheumatoid arthritis and multiple sclerosis.
Bacteroides spp. Have been involved in several infections by exhibiting antimicrobial resistance to a variety of antibiotics. Furthermore, they may act as useful commensals to the human host [
39].
The lowest abundance of Haemophilus was detected in the WD group and the highest abundance was seen in vegans (
Figure 4 and
Figure 5). If detected, the counts found for Haemophilus were in the same size range for all diets, and the median was largely driven by the presence or absence of Haemophilus (
Figure 5). Recent publications suggest negative health effects. Zhu et al. [
40] found a significant correlation between Haemophilus and psychiatric disorders such as schizophrenia, depression, and impacts on patients’ cognition and depression. The microbiome of the respiratory tract is also known to affect immune response. Here, increased levels of Haemophilus are linked to mucosal inflammation [
41]. Amongst genera such as Staphylococcus, Moraxella, and Pseudomonas, Haemophilus seems to promote pro-inflammatory Th2 and Th17 cytokines and correlate with higher levels of IgE [
42]. Further investigation needs to be done to identify possible dietary factors that may influence the prevalence of Haemophilus as part of the gut microbiome and if this genus could be a negative biomarker in relation with high carbohydrate/fiber consumption.
Conversely, we observed the highest abundance of Dorea, Ruminococcus torques group, Eubacterium ruminantium group, Ruminococcaceae, Lachnospiraceae_2, Lactobacillus, and Senegalimassilia in the WD group, while these species are lowest in vegans (
Figure 4 and
Figure 5).
In contrast to our data, Singh et al. [
43] reported that the intake of animal protein alters gut microbiota composition by increasing
Bacteroides spp.,
Alistipes spp., and
Bilophila spp., and decreasing beneficial
Lactobacillus spp.,
Roseburia spp., and Eubacterium rectale. De Angelis et al. [
30] and De Fillippis et al. [
29] also reported that Ruminococcus and the family of Ruminococcaceae were positively associated with an omnivorous diet. Additionally, higher amounts of lactic acid bacteria, including Lactobacillus and Lactococcus, were found in omnivores compared to vegans [
7]. A regular consumption of whole grain and wheat bran was associated with an increase of
Bifidobacterium spp. And
Lactobacillus spp., whereas resistant starch and whole grain barley seemed to increase lactic acid bacteria including
Ruminococcus spp., Eubacterium rectale, and
Roseburia spp. [
39]. Furthermore, a long-term consumption of fruit and vegetables as well as walnuts affects the gut microbiota composition by increasing
Ruminococcus spp. And
Bifidobacterium spp. And decreasing
Clostridium spp. [
30,
44]. These findings, however, are not supported by the current study as these foods are consumed in both diets, with much higher intakes in vegans [
2]. Ruminococcus might also play a role in the conversion of animal-derived choline to trimethylamine (TMA) [
45]. Thus, the abundance of Ruminococcus is influenced by both animal and plant-based diets.
Fat intake was the lowest in vegans, favoring beneficial Bifidobacteria in human gut microbiota, which is in accordance with our data (Bifidobacterium in WD/Flex/VG/VN: 2.1/2.9/3.4/3.1%). Previous studies found a lower abundance of both Bifidobacteria and Enterobacteria in vegans [
35,
37,
38].
In a normal gut flora, Bacteroidetes and Firmicutes represent approximately 90% of total bacterial phyla constitution, while Actinobacteria, Proteobacteria, and Verrucomicrobia are represented to a smaller extent [
39]. In plant-based diets, the fat content consists predominantly of mono- and polyunsaturated fatty acids which is related to a decrease in Firmicutes/Bacteriodetes ratio, and on the genera level, increase in lactic acid bacteria, Bifidobacteria, and Akkermansia muciniphila [
43]. In the NuEva collective, the higher Firmicutes/Bacteriodetes ratio in the WD group differed significantly from the lower ratio in vegans. A decrease in Firmicutes/Bacteriodetes ratio was also seen in response to an increased intake of resistant starches, which may support a weight management hypothesis [
46]. Recent data are inconsistent as De Fillippis et al. [
29] observed a higher ratio of Firmicutes to Bacteroidetes in omnivores, while no significant difference in this ratio was detected by Losasso et al. [
47].
Enterotypes present an initial form of pattern analysis of the gut microbiome and were introduced by Arumugam et al. [
48]. The intestinal microbiome is divided into three groups: ET_B = Bacteroides, ET_P = Prevotella, and ET_F = Firmicutes enterotypes. It was traditionally reported that Prevotella was strongly associated with a carbohydrate-rich diet. Protein and animal fat consumption would result in a Bacteroides enterotype. In our study, high carbohydrate/fiber consumption typical of vegetarian and vegan dietary patterns resulted in an increase of identified Bacteroides enterotypes in comparison to WD and Flex (
Figure 6B). This contradicts the traditional classification but is not unique. Jang et al. [
49] described similar results for their adult Korean cohort. They found diets based on plants and fermented foods are associated with higher proportions of Bacteroides and lower proportions of Prevotella relative to a WD. The animal-based foods of the WD had a stronger association with Prevotella and were related to a higher risk of obesity. A possible explanation for these contradictory observations could be found in the publication of Méndez-Salazar et al. [
50]. They investigated compositional changes of the gut microbiome in obese and undernourished children. The obese as well as the undernourished group showed lower bacterial richness and diversity than the normal-weight group. These results are in accordance with this study‘s observed alpha diversity metrics, which were reduced for vegans in comparison to WD/Flex groups. In the NuEva collective, the energy intake and the BMI were significantly low in vegans (
p < 0.05), [
2]. Interestingly, they described different associations of nutrient intake and the Bacteroides enterotype. For the obese group, the Bacteroides enterotype correlated positively with dietary fat intake, whereas for the undernourished group the Bacteroides enterotype correlated positively with carbohydrate intake. These data indicate that dietary habits differ in terms of their impact on the microbiome depending on individual baseline conditions.
Some previous studies detected greater microbial diversity in certain Bacteroidetes-related operational taxonomic units in plant-based diets or diets characterized by long-term fruit and vegetable intake [
47,
51]. In addition, the intake of whole-grain barley and brown rice increased microbial diversity in healthy volunteers [
52]. Losasso et al. [
47] found also a significantly lower alpha diversity in omnivores compared to vegans. Other studies did not report a significant difference in alpha diversity between vegans and omnivores [
29,
31]. According to our results, Trefflich et al. [
36] observed a lower alpha diversity in vegans compared to omnivores. The increased carbohydrate consumption observed in vegans may be attributed to a limited food diversity. WD is characterized by a high intake of animal-based foods. An increase in the proportion of carbohydrates is usually accompanied by an increase in the proportion of plant-based foods. This increase in food diversity could have a favorable effect on the parameters studied and could explain the opposing trend in alpha diversity among both diet groups.
The data available from the NuEva collective show great differences in the energy and nutrient intake between vegans and omnivores, whereby the intakes in both diets are inversely related [
2]. This, in turn, has an impact on microbiome composition (
Figure 4 and
Figure 5).
The data on alpha and beta diversity account for the difference in the fecal bacterial composition between high-fiber and low-fiber dietary patterns. This was also observed within diet groups. Together with the observed reduction in alpha diversity in the vegan group, we conclude that limited food choices and the extremely high intake of dietary fibers result in a reduction in the microbial diversity (
Table 7 and
Table 9). Interestingly, the intake of soluble fibers in vegans was not related to a reduction in the microbial diversity (
Table 9). The higher intake of soluble fibers in vegans (Median/IQR: 10.1/4.6 g/day; 1.8–30.8 g/day) differs significantly from the other three diet groups (7.9–9.0 g/day; 3.3–24.7 g/day,
p < 0.05) [
2]. A regular intake of soluble fiber-rich foods such as oats, whole barley, legumes, peas, beans, flax seeds, apples, and citrus foods was associated with a reduction in total and low-density lipoprotein cholesterol levels by about 5–10% [
53,
54]. This is in line with our data [
2].
No correlations between dietary fiber intake and alpha diversity were observed in flexitarians and vegetarians. An increased fiber consumption in WD expresses itself in a more evenly distributed microbiome (
Table 7 and
Table 9). This is in accordance with latest findings that described a relation between dietary fiber intake and overall metabolic health, in particular through key pathways that include insulin sensitivity. In addition, a reduction in cardiovascular risk factors, such as blood lipids (mainly due to consumption of soluble fibers), body weight, and abdominal adiposity was reported. Dietary fiber intake is also related to a reduction in mortality and colorectal carcinoma risk. In this context, the gut microflora mediates health benefits of dietary fiber, including the regulation of appetite, metabolic processes, and chronic inflammatory pathways [
55].
On the other hand, a high intake of dietary fibers is associated with a high intake of phytic acid, which has a high affinity to chelated Zn
2+ and Fe
2+, Mg
2+, Ca
2+, K
+, and Mn
2+ and Cu
2+. Consequently, the trace elements and minerals chelated in phytic acid are not bioavailable. Given the fact that these micronutrients are critical nutrients, especially in plant-based diets, the reduction in their bioavailability increases the risk for micronutrient deficiencies affecting growth, development, and overall health [
56].
Regardless of the fiber group, vegans showed significantly different microbiome compositions than the WD group (
Table 4), indicating that the microbiome may not be affected by single macronutrients but rather must be assessed in the context of overall nutrition. In the NuEva collective, reduced intake of energy, fat, and saturated fatty acids and an increased intake of dietary fibers in vegans resulted in a reduction in total cholesterol and LDL cholesterol, both of which are established risk factors for cardiovascular diseases [
2,
57]. A LefSe analysis allowed us to identify 14 diet-specific biomarkers at the genus level. Of these, 11 showed minimum or maximum counts in the respective “extreme” diet groups WD and VN. In vegans, we found mainly fermenters (Lachnospiraceae, Butyricoccus, Lachnospiraceae UCG_004), which correlated negatively with cardiovascular risk factors such as BMI, blood pressure, and blood lipid values (
Figure 7). In contrast to previous studies, we detected Bacteroides as the main enterotype in vegans, showing similar behavior to the other VN-specific biomarkers. This discrepancy also illustrates here that it is not always possible to make a generally valid statement.
On the other hand, WD-specific biomarkers showed mostly positive correlations with BMI and blood lipids. These include Dorea, a genus of harmful bacteria. Current studies also show a link to insulin resistance, and this genus is also considered as a risk marker for colorectal cancer and irritable bowel syndrome [
58]. Unexpectedly, an uncultured genus of Lachnospiraceae was shown to be a biomarker for WD, which also revealed several significant positive correlations with BMI, blood pressure, and total and LDL cholesterol. Bacteria from this genus are known to produce SCFAs, which are associated with a positive impact on gut health. Lactobacillus was also identified as a biomarker for WD but did not show significant correlations. Its identification in some vegans could result from consumption of fermented vegetables such as sauerkraut or kimchi, as well as miso or kombucha.
Apart from the described differences in the intake of energy and dietary fibers in the NuEva collective, the amount and composition of protein and fat differs also markedly between the WD groups and vegans [
2]. Further studies which take the effects on the diversity and composition of the microbiome into account will need to be undertaken.
5. Conclusions
This study has shown the distinction between energy intake and consumption of dietary fibers between omnivores (WD) and vegans. This disparity is reflected in differences in the microbiome profile. In addition, we found a negative correlation between alpha diversity and energy, carbohydrates, and dietary fiber intake only in the vegan group. Our data indicate that the comparable high intake of dietary fibers in vegans leads to a restriction of the diversity of the microbiome. Interestingly, this relation does not apply to the intake of soluble fiber. In addition, the high intake of dietary fibers may reduce the bioavailability of trace elements and minerals but also reduce cardiovascular risk factors.
The findings reported here shed new light on the advantages and disadvantages of the studied diets. Identifying biomarkers for the diets on the extreme end of the spectrum (WD and VN) and their association with cardiovascular risk factors highlights the potential and the need for the development of personalized recommendations depending on dietary patterns. Our data both confirm and contradict the findings of other studies, underscoring the need for further research. In addition, several questions on the meaning of the detected diet-specific differences in microbiome composition cannot be adequately answered. The elucidation of these associations will form the basis for personalized nutritional recommendations based on the microbiome.
Regarding fiber intake, our data indicate that optimal diversity of the human microbiome can be achieved by an increase in the WD and an upward restriction for vegans.
Conversely, the high intake of dietary fiber in vegans, soluble fiber in particular, is associated with a reduction in cardiovascular risk factors such as BMI, blood pressure, and blood lipids. To maintain these favorable effects, strategies to increase the variety of food sources within a particular dietary lifestyle are urgently needed.
For vegans, the recommendation to include all varieties of vegetables, pulses, whole-grains, nuts, seeds, and micro- and macroalgae, as well as plant-based oils and fermented foods, seems to be a promising opportunity. To increase bioavailability of the nutrients, the usage of appropriate methods of preparation is also advisable.
For WD, partial replacement of animal foods with plant foods is similarly advisable.
Both strategies based on the habitual diet form will contribute to reducing cardiovascular risk factors and increase the diversity of the microbiome.