Fasting alters the gut microbiome with sustained blood pressure and body weight reduction in metabolic syndrome patients

Periods of fasting and refeeding may reduce cardiometabolic risk elevated by Western diet. We show that in hypertensive metabolic syndrome patients, a 5-day fast followed by a modified Dietary Approach to Stop Hypertension diet reduced systolic blood pressure, need for antihypertensive medications, body-mass index at three months post intervention compared to a modified Dietary Approach to Stop Hypertension diet alone. Fasting altered the gut microbiome, impacting bacterial taxa and gene modules associated with short-chain fatty acid production. Cross-system analyses revealed a positive correlation of circulating mucosa-associated invariant T cells, non-classical monocytes and CD4+ effector T cells with SBP. Furthermore, regulatory T cells positively correlated with body mass index and weight. Machine learning analysis of baseline immunome or microbiome data could predict sustained systolic blood pressure response within the fasting group, identifying CD8+ effector T cells, Th17 cells and Tregs or Desulfovibrionaceae, Hydrogenoanaerobacterium, Akkermansia, and Ruminococcaceae as important contributors to the model.