Fig. 5

Green-MED adherence, cardiometabolic markers, and the association with specific bacteria and microbial metabolic pathways. A Left: Forest plot of Green-MED adherence score and its components following 6 months of dietary intervention across groups. Adherence was assessed using a 9-dimensional index, ranging from 0 (non-adherence) to 9 (full adherence). Right: Associations between changes in the corresponding dietary component on the left and compositional change (log2 fold change of all ASVs) by performing PERMANOVA test on the Euclidean distance matrix. Green-MED dieters adhered to their assigned intervention, with intake of specific components (tea and walnuts) being associated with microbiome compositional shift. B, C Heatmap showing the association patterns of changes in the Green-MED adherence score and change in genus taxa (B) and KEGG modules (C). Features are arranged from top to bottom by their correlations with the adherence score. For each cell, colors indicate the Spearman rho values. Several links between change in microbial features and change in biomarkers were observed. Specifically, changes in specific Green-MED-associated bacteria and microbial metabolic, e.g., Bifidobacterium and Leucin (BCAA) degradation, were associated with weight change following the intervention. D Mediation analysis: assessing the proportional mediatory effect of change in all genus-level taxa (calculated as #1 principal component of their change matrix) in the association between lifestyle intervention and weight change. Weight loss and Framingham risk score were found to be partially mediated by changes in the gut microbiome. ****FDR < 0.001, ***FDR < 0.01, **FDR < 0.05, *FDR < 0.25, ^#P value < 0.05. FRS, Framingham risk score; MAP, mean arterial pressure; HDG, healthy dietary guidance; HOMA-IR, homoeostatic model assessment of insulin resistance; LDLc, low-density lipoprotein cholesterol; MED, Mediterranean