A Swedish dietary guideline index, gut microbial α-diversity and prevalence of metabolic syndrome - observations in the Swedish CArdioPulmonary bioImage Study (SCAPIS)

Ulrika Ericson; Sophie Hellstrand; Anna Larsson; Mariam Miari; Sergi Sayols-Baixeras; Koen F Dekkers; Göran Bergström; Andrei Malinovschi; Gunnar Engström; Johan Ärnlöv; Tove Fall; Marju Orho-Melander

doi:10.29219/fnr.v68.10547

A Swedish dietary guideline index, gut microbial α-diversity and prevalence of metabolic syndrome - observations in the Swedish CArdioPulmonary bioImage Study (SCAPIS)

Food Nutr Res. 2024 Nov 28:68. doi: 10.29219/fnr.v68.10547. eCollection 2024.

Authors

Ulrika Ericson¹, Sophie Hellstrand¹, Anna Larsson¹, Mariam Miari¹, Sergi Sayols-Baixeras^{2

3

4}, Koen F Dekkers^{2

3}, Göran Bergström^{5

6}, Andrei Malinovschi⁷, Gunnar Engström⁸, Johan Ärnlöv^{9

10}, Tove Fall^{2

3}, Marju Orho-Melander¹

Affiliations

¹ Department of Clinical Sciences in Malmö, Diabetes and Cardiovascular Disease, Lund University, Malmö, Sweden.
² Molecular Epidemiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
³ SciLifeLab, Uppsala University, Uppsala, Sweden.
⁴ CIBER Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
⁵ Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁶ Department of Clinical Physiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
⁷ Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.
⁸ Department of Clinical Sciences in Malmö, Cardiovascular Research-Epidemiology, Lund University, Malmö, Sweden.
⁹ Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden.
¹⁰ School of Health and Social Studies, Dalarna University, Falun, Sweden.

Abstract

Background: Metabolic syndrome (MetS) is characterized by coexisting risk factors for type 2 diabetes and cardiovascular disease. Diet is of importance in their aetiology, and gut microbiota (GM) may constitute a link between diet and metabolic health. Understanding the interplay between diet and GM could contribute novel insights for future dietary guidelines, and aid in preventive actions to motivate adherence to dietary guidelines.

Objective: We intended to create a Swedish dietary guideline index (SweDGI) measuring adherence to 12 Swedish dietary guidelines and examine whether SweDGI and its components are associated with GM α-diversity (Shannon index) and prevalent MetS, and if the association between the Shannon index and MetS differs depending on SweDGI.

Design: SweDGI was based on food-frequency data assessed 2014-2018 in 10,396 diabetes-free participants from the Malmö and Uppsala-sites of the Swedish CArdioPulmonary bioImage Study (SCAPIS) (50-64 y, 53% women). We estimated the Shannon index from shotgun metagenomic sequencing-data to assess microbial richness and evenness. We used a general linear model to examine cross-sectional SweDGI-Shannon associations and logistic regression for associations with MetS.

Results: Most guidelines were followed by less than half of the participants. Men showed poorer adherence. Higher SweDGI was linked to higher Shannon index (P-trend across five SweDGI-groups = 1.7 × 10^-12). Most guidelines contributed to this observation. Higher SweDGI and Shannon index were associated with lower MetS-prevalence, where the lowest prevalence was observed among those with both high SweDGI and high Shannon index (odds ratio:0.43; 95% confidence interval:0.35, 0.52). Both the Shannon index and SweDGI were associated with MetS, independently of the level of the other factor (P-interaction = 0.82).

Conclusions: We created a new index to comprehensively reflect adherence to the Swedish dietary guidelines in sub-cohorts within the large multicentre SCAPIS study. Better adherence was associated with a richer and more even GM and lower prevalence of MetS. The inverse association between the Shannon index and MetS was consistent at different levels of adherence to dietary guidelines.

Keywords: epidemiology; food patterns; gut microbiota; metabolic syndrome.

Grants and funding

The Swedish CArdioPulmonary bioImage Study (SCAPIS) was funded mainly by the Swedish Heart-Lung Foundation. The study was also funded by the Knut and Alice Wallenberg Foundation, the Swedish Research Council and VINNOVA (Sweden’s innovation agency). The SCAPIS-Malmö was additionally supported by Lund University and Skåne University Hospital, and SCAPIS-Uppsala by Uppsala University and University Hospital.