The “living well with lupus” lifestyle intervention: Effects on gut microbiota in patients with systemic lupus erythematosus and high cardiovascular risk

Background Systemic lupus erythematosus (SLE) is an autoimmune disease associated with increased cardiovascular risk and gut microbiota dysbiosis. Although lifestyle can modulate the microbiome, the impact of multidisciplinary interventions in SLE remains unclear. Thus, the aim of the present study was to investigate the effects of a multidisciplinary lifestyle intervention on gut microbiota diversity and composition in women with SLE and high cardiovascular risk. Materials and methods This study analyzed a subsample ( n = 31) from the “Living Well with Lupus” (LWWL) study, a 6-month randomized controlled trial. Patients were assigned to a lifestyle intervention + standard care (LWWL) or a standard care control group (CG). Gut microbiota (16S rRNA sequencing), fecal short-chainfatty acids (SCFAs), selected cardiovascular risk factors, dietary intake, and physical activity levels were assessed before and after the intervention. Results No significant changes were observed in cardiovascular risk factors, food intake, or physical activity levels. Fecal SCFA concentrations and alpha/beta diversity also remained stable. Exploratory taxonomic analyses nevertheless identified distinct relative-abundance patterns across groups and time, including a numerical increase in the Firmicutes -to- Bacteroidota (F/B) ratio in LWWL and different trajectories of several SCFA-associated genera. Among these, Blautia and Parasutterella increased, whereas Butyricimonas , Coprococcus , and Odoribacter decreased from pre- to post-intervention in LWWL, with different trajectories observed in CG across these genera. Conclusions These findings suggest that taxonomic features of the gut microbiota may show compositional variation following a lifestyle intervention even in the absence of detectable changes in the measured cardiometabolic or behavioral outcomes. However, the functional and clinical significance of these exploratory taxonomic patterns remains uncertain and warrants further investigation.