The impact of diet and ethnicity on Gut Microbiota Variation in Irritable Bowel Syndrome: A Multi‐centre Study

Background
The gut microbiota in irritable bowel syndrome (IBS) is known to vary with diet. 

Aims
i) To analyse the gut microbiota composition of IBS patients from a multi-ethnic population and ii) explore the impact of a low FODMAP diet on gastrointestinal symptoms and gut microbiota composition amongst IBS patients. 

Methods
A multi-centre study of multi-ethnic Asian patients with IBS was conducted in two phases: i) an initial cross-sectional gut microbiota composition study of IBS patients and healthy controls, followed by ii) a single-arm 6-week dietary interventional study of the IBS patients alone, exploring clinical and gut microbiota changes. 

Results
A total of 34 adult IBS patients (IBS sub-types of IBS-D 44.1%, IBS-C 32.4% and IBS-M 23.5%) and 15 healthy controls were recruited. A greater abundance of Parabacteroides species with lower levels of bacterial fermenters and short-chain fatty acids producers were found amongst IBS patients compared with healthy controls. Age and ethnicity were found to be associated with gut microbiota composition. Following a low FODMAP dietary intervention, symptom and quality of life improvement were observed in 24 (70.6%) IBS patients. Symptom improvement was associated with adherence to the low FODMAP diet (46.7% poor adherence vs 92.9% good adherence, p=0.014), and gut microbiota patterns, particularly with a greater abundance of Bifidobacterium longum, Anaerotignum propionicum and Blautia species post-intervention. 

Conclusion
ut microbiota variation in multi-ethnic IBS patients may be related to dietary intake and may be helpful to identify patients who are likely to respond to a low FODMAP diet.

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