Fig. 4

Six-month changes in cardiometabolic markers and their associations with changes in global microbiome composition. Left: Forest plot of percent change in cardiometabolic health markers following 6 months of dietary intervention across groups. Significant changes in biomarkers are shown (FDR-corrected P Kendell tau < 0.25). Right: Associations between changes in the corresponding biomarker on the left and composition change (log2 fold change of all ASVs) by performing PERMANOVA test on a Euclidean distance matrix. The Green-MED diet improved cardiometabolic health, with changes in a subset of biomarkers, including body weight, waist circumference, blood pressure, and glycemic profile, being associated with microbiome compositional shift. ****FDR < 0.001, ***FDR < 0.01, **FDR < 0.05, *FDR < 0.25. FRS, Framingham Risk Score; GGT, gamma glutamyl transferase; SBP/DBP, systolic/diastolic blood pressure; MAP, mean arterial pressure; HDG, healthy dietary guidance; HDLc, high-density lipoprotein cholesterol; HOMA-IR, homoeostatic model assessment of insulin resistance; LDLc, low-density lipoprotein cholesterol; MED, Mediterranean; TC, total cholesterol; TG, triglycerides