Effects of Lactiplantibacillus plantarum on moderate dyslipidemia before medication involving gut microbiota and host genetics

In this 12-week trial, 136 participants with moderately dyslipidemia were randomly assigned to receive Lactiplantibacillus plantarum (LP) or placebo. In the intention-to-treat analysis, the group-by-time interaction did not reach statistical significance. However, in per-protocol set (adherence ≥85% and no antibiotic use), LP supplementation reduced low-density lipoprotein cholesterol (LDL-C) (−0.118 mmol/L) and total cholesterol (TC) (−0.163 mmol/L), compared with the placebo (both P_group×time < 0.05). Post-intervention group differences were identified in gut microbial genera and species, correlated with changes in bile acids, which in turn were jointly related to lipid reduction. Microbiota-based machine learning models well-predicted the lipid reductions. Subjects with lower genetic risk scores experienced large decreases in LDL-C (Mean ± SD: −0.749 ± 0.632 mmol/L) and TC (−1.306 ± 0.436 mmol/L) (both P_trend and P_interaction < 0.001). Our data supported the beneficial effects of LP in patients with moderate dyslipidemia involving gut microbiota and host genetics.