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Interventions and public health nutrition

Pretreatment Prevotella-to-Bacteroides ratio and markers of glucose metabolism as prognostic markers for dietary weight loss maintenance



Pre-treatment gut microbial Prevotella-to-Bacteroides (P/B) ratio and markers of glucose metabolism (i.e., fasting glucose and insulin) have been suggested as biomarkers for optimal weight management. However, both biomarkers need further validation, and the interactions between them for optimal weight management are largely unknown. To investigate differences in weight loss maintenance between subjects with low and high P/B ratio and the potential interactions with markers of glucose metabolism and dietary fiber intake.


Following an 8-week weight loss period using meal replacement products, subjects losing ≥ 8% of their initial body weight were randomized to one of three protein supplements or maltodextrin for a 24-week weight maintenance period. Habitual diet was consumed along with the supplements expected to constitute 10–15% of total energy. For this analysis we stratified the participants into low and high strata based on median values of pre-intervention P/B ratio, pre-weight loss Homeostatic model assessment of insulin resistance (HOMA-IR) (<2.33 or > 2.33), and dietary fiber intake during the intervention (< 28.5 or > 28.5 g/10 MJ).


Regardless of weight maintenance regimen, subjects with high P/B ratio (n = 63) regained 1.5 (95% CI 0.4, 2.7) kg body weight (P = 0.007) more than subjects with low P/B ratio (n = 63). The regain among subjects with high P/B ratio was particular evident if HOMA-IR was high and dietary fiber intake was low. Consequently, in the high P/B strata, subjects with high HOMA-IR and low fiber intake (n = 17) regained 5.3 (95% CI 3.3, 7.3) kg (P < 0.001) more body weight compared with participants with low HOMA-IR and high fiber intake (n = 16).


Subjects with high P/B ratio were more susceptible to regain body weight compared with subjects with low P/B ratio, especially when dietary fiber intake was low and glucose metabolism was impaired. These observations underline that both the P/B ratio and markers of glucose metabolism should be considered as important biomarkers within personalized nutrition for optimal weight management.

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MFH and AA designed the overall research plan for this stratified analysis; MFH performed statistical analysis; MFH wrote paper; MFH have primary responsibility for final content; All authors have contributed to the discussion of analyses, reviewed the paper critically and approved the final paper. Arla Foods Ingredients Group P/S contributed to the overall study design but none of the funders had any role in the collection, management, analysis, interpretation of the data, preparation, review, or approval of the paper.


The original study was supported by Arla Foods, Viby J, Denmark, Arla Foods Ingredients Group P/S, Viby J, Denmark, and the Faculty of Science, University of Copenhagen, Denmark, all of which provided financial support. Arla Foods Ingredients Group P/S, Viby J, Denmark, and NUPO A/S, Taastrup, Denmark, donated intervention and low-calorie–diet products, respectively. The work reported in this paper was partly funded by grants from Gelesis Inc, Boston, USA.

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Correspondence to Mads F. Hjorth.

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MFH and AA are co-inventors on a pending provisional patent application for the use of biomarkers to predict responses to weight loss diets. AA is the co-inventor of other related patents and patent applications that are owned by UCPH, in accordance with Danish law. AA is a consultant for Gelesis Inc., providing scientific advice unrelated to the current paper. AA is a consultant or member of the advisory boards of Groupe Ethique et Sante, France; Weight Watchers, United States; BioCare, Copenhagen; Zaluvida, Switzerland; Novo Nordisk, Denmark; and Saniona, Denmark. MFH and AA are co-authors of the book Spis dig slank efter dit blodsukker (Eat healthily according to your blood sugar), published by Politikens Forlag, Denmark, and of other books about personalized nutrition for weight loss. AA is co-owner and member of the board of the consultancy company Dentacom ApS, Denmark, and cofounder and co-owner of the UCPH spin-off Mobile Fitness A/S and Flax-Slim ApS. MFH and AA are co-founders and co-owners of the UCPH spin-off Personalized Weight Management Research Consortium ApS ( Remaining authors reported no conflict of interest.

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Hjorth, M.F., Christensen, L., Kjølbæk, L. et al. Pretreatment Prevotella-to-Bacteroides ratio and markers of glucose metabolism as prognostic markers for dietary weight loss maintenance. Eur J Clin Nutr 74, 338–347 (2020).

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