Low fibre intake is associated with gut microbiota alterations in chronic heart failure

Abstract

Aims Recent reports have suggested that patients with heart failure (HF) have an altered gut microbiota composition; however, associations with diet remain largely uninvestigated. We aimed to explore differences in the gut microbiota between patients with HF with reduced ejection fraction and healthy controls, focusing on associations with diet and disease severity. Methods and results The microbiota composition of two cross-sectional cohorts (discovery, n = 40 and validation, n = 44) of patients with systolic HF and healthy controls (n = 266) was characterized by sequencing of the bacterial 16S rRNA gene. The overall microbial community (beta diversity) differed between patients with HF and healthy controls in both cohorts (P < 0.05). Patients with HF had shifts in the major bacterial phyla, resulting in a lower Firmicutes/Bacteroidetes (F/B) ratio than controls (P = 0.005). Patients reaching a clinical endpoint (listing for heart transplant or death) had lower bacterial richness and lower F/B ratio than controls (P < 0.01). Circulating levels of trimethylamine-N-oxide were associated with meat intake (P = 0.016), but not with gut microbiota alterations in HF. Low bacterial richness and low abundance of several genera in the Firmicutes phylum were associated with low fibre intake. Conclusions The gut microbiota in HF was characterized by decreased F/B ratio and reduced bacterial diversity associated with clinical outcome. The gut microbiota alterations in HF were partly related to low fibre intake, emphasizing the importance of diet as a covariate in future studies. Our data could provide a rationale for targeting the gut microbiota in HF with high-fibre diet.

The gut microbiome in coronary artery disease and heart failure: Current knowledge and future directions

“…We recently measured circulating butyrate in plasma from patients with HF, but found no association with gut dysbiosis, possibly due to low circulating levels of butyrate [66]. Butyrate and other SCFAs can be measured in fecal samples, providing a more direct measure of microbial activity, but this requires snap frozen samples without preservatives.…”

Microbiota-Derived Metabolite Trimethylamine N-Oxide Protects Mitochondrial Energy Metabolism and Cardiac Functionality in a Rat Model of Right Ventricle Heart Failure

“…Moreover, dietary choices determine the composition of intestinal microbiota, which further unambiguously affects the host metabolism (Lindsay et al, 2020 ). It has been shown that chronic heart failure is characterized by substantial alterations in gut microbiome composition and reduced microbial variety (Kummen et al, 2018 ; Mayerhofer et al, 2020 ). Previous studies suggest a link between the human gut microbiome and the homeostasis of energy metabolism, however, a clear causal relationship between them remains elusive.…”

A Mouse Model Suggests That Heart Failure and Its Common Comorbidity Sleep Fragmentation Have No Synergistic Impacts on the Gut Microbiome

“…Indeed, previous studies have shown evidence implicating the gut microbiome in the physiopathology and prognosis of HF [ 7 ]. HF is associated with reduced microbiome diversity [ 8 ] and a shift in the major bacterial phyla, resulting in a lower Firmicutes/Bacteroidetes ratio [ 9 ], and an increase in Enterobacterales , Fusobacterium and Ruminococcus gnavus , but also in a decrease in Coriobacteriaceae , Erysipelotrichaceae , Ruminococcaceae , and Lachnospiraceae [ 8 ]. Moreover, some intestinal microbial metabolites (e.g., trimethylamine-N-oxide (TMAO) and its precursors) are present in higher amounts in patients with chronic HF, and elevated levels of TMAO have been independently associated with an increased risk of mortality in acute and chronic HF [ 10 ].…”