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MORAES, A.C.F. Gut microbiota analysis of adults with distinct dietary habits and associations with inflammation and insulin resistance. [Doctoral thesis]. School of Public Health, USP, São Paulo; 2016. Introduction: The gut microbiota has great bacterial diversity, predominantly of the phyla Bacteroidetes and Firmicutes, with multiple functions. Diet can alter their composition and function. High amount of saturated fat alters intestinal permeability, raises the lipopolysaccharides and predisposes to low-grade inflammation. High-fiber diet, such as the vegetarian, induces the elevation of short-chain fatty acids and metabolic benefits. Objectives: To analyze the composition of gut microbiota of Adventists with diverse dietary patterns and associate them to the low grade inflammation and insulin resistance this thesis included: 1) review of underlying mechanisms of the association of diet, gut microbiota composition and cardiometabolic risk; 2) analysis of the gut microbiota composition according to different dietary patterns and associations with biomarkers of cardiometabolic diseases; 3) evaluation of the association between the Akkermansia muciniphila abundance and glucose metabolism; 4) analysis of the presence of enterotypes and associations with clinical characteristics. Methods: This cross-sectional study included 295 Adventists stratified according to dietary patterns (strict vegetarian, lacto-ovo-vegetarian and omnivore). Their associations with clinical, biochemical and inflammatory data were evaluated. The microbiota profile was obtained by sequencing 16S rRNA genes (Illumina® Miseq). Results: 1) There are evidences that the relationship among diet, inflammation, insulin resistance and cardiometabolic risk are partly mediated by the gut microbiota. 2) Vegetarians showed better clinical profile when compared to omnivores. It was confirmed greater abundance of Firmicutes and Bacteroidetes, which did not differ according to adiposity. However, strict vegetarians had more Bacteroidetes, fewer Firmicutes and higher abundance of genus Prevotella when compared to the other two groups of dietary patterns. The lacto-ovo-vegetarians had higher proportion of Firmicutes especially the genus Faecalibacterium. In the omnivores, there was overrepresentation of the Gammaproteobacteria (Succinivibrio and Halomonas) compared to vegetarians. 3) Normoglycemic individuals had higher abundance of Akkermansia muciniphila compared to those with abnormal glycemic profile. The abundance of this bacterium was inversely correlated to fasting glucose and glycated hemoglobin. 4) Three enterotypes were identified (Bacteroides, Prevotella and Ruminococcaceae), similar to those previously described. LDL-C concentrations were lower in enterotype 2, in which a higher frequency of strict vegetarians was found. Discussion: 1) Knowledge on the involvement of the microbiota in the pathophysiology of diseases could reverse on strategies to manipulate it to promote health. 2) Our data support the hypothesis that dietary patterns could be favorably or unfavorably associated with metabolic and inflammatory processes, via changes in the gut microbiota composition. We suggest that exposure to animal food could negatively impact on the proportions of bacterial communities. 3) We also suggest that the abundance of Akkermansia muciniphila can participate in the glucose metabolism. 4) We reinforce that the existence of three enterotypes should not be specific to certain populations/continents. Although the biological significance of these clusters remains unknown, the correlations with lipid profile may suggest their usefulness in the assessment of the cardiometabolic risk. Conclusions: Our findings reinforce the idea that the gut microbiota composition is altered by different dietary patterns, which, in turn, are associated with changes in metabolic and inflammatory profiles. Prospective studies should investigate the potential of diet to prevent microbiota-mediated cardiometabolic disorders. Key-words: microbiota, dietary patterns, adiposity, inflammation, insulin resistance.

Análise da microbiota intestinal em adultos com hábitos alimentares distintos e de associações com a inflamação e resistência à insulina