Gut Microbiome of Indonesian Adults Differently Associated with Obesity and type 2 Diabetes under Varied Dietary Habits: A Cross-sectional Study in an Asian Developing City, Yogyakarta

Indonesia is a developing country facing the national problem of the growing obesity and diabetes in its population due to recent drastic dietary and lifestyle changes. To understand the interface between the gut microbiome, diet, and health of Indonesian people, we characterized fecal microbiomes and metabolomes of 75 Indonesian adults in Yogyakarta City, including 21 obese people and 25 type 2 diabetes (T2D) patients, together with their dietary and medical records. Variations of microbiomes showed a triangular distribution in the principal component analysis, driven by three dominant bacterial genera, namely Bacteroides, Prevotella, and Romboutsia. The Romboutsia-driven microbiome, characterized by low bacterial diversity and high primary bile acids, was associated with fat-driven obesity. The Bacteroides-driven microbiome, which counteracted Prevotella but was associated with Ruminococcaceae concomitantly increased with high-carbohydrate diets, showed positive correlation with T2D indices but negative correlation with body mass index. Notably, Bacteroides fragilis was increased in T2D patients with a decrease of fecal conjugated bile acids, particularly tauroursodeoxycholic acid, a farnesoid X receptor antagonist with anti-diabetic activity, while these features disappeared in patients administered metformin. These results indicate that the gut microbiome status of Indonesian adults is differently associated with obesity and T2D under their varied dietary habits.