European Journal of Clinical Nutrition

https://doi.org/10.1038/s41430-020-0607-6

REVIEW ARTICLE

Profile of the gut microbiota of adults with obesity: a systematic review

Louise Crovesy1 Daniele Masterson2 Eliane Lopes Rosado1
● ●

Received: 27 May 2019 / Revised: 4 March 2020 / Accepted: 6 March 2020

© The Author(s), under exclusive licence to Springer Nature Limited 2020

Abstract
Recently, relationship between gut microbiota composition and development of obesity has been pointed. However, the
gut microbiota composition of individual with obesity is not known yet. Therefore, this systematic review aimed to
evaluate differences in profile of gut microbiota between individuals with obesity and individuals with normal weight. A
search performed on August 2019 in the databases Pubmed, Scopus, Web of Science, Cochrane library, Lilacs and gray
literature using the terms: “microbiota”, “microbiome”, “obesity”, “obesity morbid”, and “humans”. Studies assessing
the gut microbiota composition in adults with obesity and lean were included. Quality assessment was performed by
Newcastle–Ottawa Quality Assessment Scale. Of the 12,496 studies, 32 were eligible and included in this review.
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Individuals with obesity have a greater Firmicutes/Bacteroidetes ratio, Firmicutes, Fusobacteria, Proteobacteria,
Mollicutes, Lactobacillus (reuteri), and less Verrucomicrobia (Akkermansia muciniphila), Faecalibacterium
(prausnitzii), Bacteroidetes, Methanobrevibacter smithii, Lactobacillus plantarum and paracasei. In addition, some
bacteria had positive correlation and others negative correlation with obesity. Individuals with obesity showed profile of
gut microbiota different than individual lean. These results may help in advances of the diagnosis and treatment of
obesity.

Introduction most frequent in the microbiota, corresponding to 90% of

Obesity is a growing public health problem throughout the
world, affecting 650 million adults worldwide. Obesity is
difficult to control due to multiple etiological factors [1]
and amongst the causes the gut microbiota has been
highlighted [2].
The gut microbiota is composed mainly of bacteria fol-
lowed by smaller proportions of fungi, virus and Archea [3].
The main phyla of bacteria in the gut microbiota are Fir-
micutes, Bacteroidetes, Proteobacteria, Actinobacteria, and
Verrucomicrobia. Firmicutes and Bacteroidetes are the
Supplementary information The online version of this article (https://
doi.org/10.1038/s41430-020-0607-6) contains supplementary
material, which is available to authorized users.
* Louise Crovesy
louisecrovesy@yahoo.com.br
1
Instituto de Nutrição Josué de Castro, Universidade Federal do Rio
de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
2
Library of Health Sciences Center, Universidade Federal do Rio de
Janeiro, Rio de Janeiro, Brazil
the gut bacteria [4, 5].
On 2004, Bäckhed et al. [6] published the first article
about the role of gut microbiota in the host metabolism,
including body weight control. Animal model and humans’
studies have been carried out to discover the composition of
the gut microbiota associated with obesity [2, 7–10].
Experimental studies with animals have shown success
in determining the association between the Firmicutes/
Bacteroidetes ratio and obesity [2, 7, 8]. However, in
humans this affirmation has not been confirmed [9–12]. In
addition, other phyla and bacteria genera have been asso-
ciated with obesity [11–14]. Therefore, we carried out a
systematic review aimed to evaluate the differences between
the profile of the gut microbiota of individuals with obesity
and individuals with lean.
Methods
Search strategy and registration
A systematic review was carried out to answer the question:
“Is the gut microbiota profile of individuals with obesity
different of lean individuals?”.

The eligibility criteria were based on the PICOS strat-
egy: Population (P), Intervention (I), Comparison (C),
Outcome (O), Study design (S). The literature search was
carried out on August 2019 using five scientific databases:
Medline via Pubmed, Scopus, Web of Science, Food Sci-
ence and Technology Abstracts (FSTA), Cochrane library,
Lilacs, and gray literature (Tripdatabase, Open Gray,
Google Scholar, Digital Library of Theses and Disserta-
tions and the Universidade de São Paulo). We followed the
PRISMA statement to carry out the present systematic
review [15].
The search strategy combined MESH (Medline), DeCs
(VHL) terms, and free terms using the boolean operators
“AND” and “OR”. “Microbiota”, “microbiome”, “obesity”,
and “morbid obesity” were the terms used in the search. The
search protocols for each scientific database can be found in
the supplementary material. A complementary search was
carried out in the references of studies included.
The studies identified were imported to the EndNote
Web Software (Thomson Reuters, New York, USA), and
duplicate articles were identified and excluded.
The present systematic review was registered in the
International Prospective Register of Systematic Reviews
(PROSPERO) under the number: CRD42018107414
(https://www.crd.york.ac.uk/PROSPERO/).
Eligibility criteria
Observational human studies and clinical trials that eval-
uated the gut microbiota composition in adults with obe-
sity and in those of normal weight by any validated
technique, written in English, Spanish or Portuguese,
were included.
Studies with animal models, children, teenagers and
pregnant; clinical trials with no gut microbiota composition
baseline data; evaluation of oral, stomach, skin or oro-
pharyngeal microbiota; studies not compared with lean
individuals; and studies with a high risk of bias (poor
quality), were excluded.
Quality assessment and risk of bias
The studies included were submitted to a quality assess-
ment by the Newcastle–Ottawa Quality Assessment Scale
[16]. This instrument includes three domains: selection,
comparability, and outcomes. The selection domain is
composed of by four items, comparability of one item,
and outcomes of three items. The article could receive
one star in each item, receiving a maximum four stars
in selection, one or two in comparability, and three in
outcomes [16]. A high risk of bias occurred when some
domain did not receive star, and in this case, the article
was excluded.
L. Crovesy et al.
Data extraction
The data extracted from the studies included in this sys-
tematic review was summarized in Table 1, giving the
following information: author and year of publication,
country and period of study/seasons (when informed),
sample size and characterization of the study population,
method used to evaluate the gut microbiota and bacteria
analyzed (if applicable), and outcomes.
Results
Literature search
Of the 12,496 studies found in the search (scientific literature
(n = 9881—Pubmed (n = 2800), Scopus (n = 3393), Web of
science (n = 2426), FSTA (n = 887), Cochrane library (n =
300), Lilacs (n = 75)), and gray literature (n = 2615)), the full
texts of only 53 articles were read, after the removal of
duplicates and screening of the title and abstract (Fig. 1). One
thesis was not available for full-text reading. Thirty-two
articles are included and are described in Table 1.
Quality and risk of bias
The quality scores of the studies can be found in Table 1.
Three articles [17–19] received the maximum score and
seven [17, 20, 21] showed good quality with eight points.
Two articles did not explain the recruitment process
[22, 23]. So they were excluded from the systematic review,
due to a high risk of bias.
Studies characteristics
Of the 32 studies included, three found no difference
between the gut microbiota of individuals with obesity and
normal weight [17–19]. Differences found between the gut
microbiota compositions are shown in the next sections.
Diversity, richness, and total number of bacteria
Verdam et al. [24], Dorminianni et al. [20], and De la
Cuesta-Zuluaga et al. [25] identified less diversity in indi-
viduals with obesity, while Kocelak et al. [12] and Kasai
et al. [26] found greater diversity and a larger total number
of bacteria. The microbiota was richer in individuals with
obesity [26, 27].
Firmicutes/bacteroidetes ratio
One study showed a lower Firmicutes/Bacteroidetes ratio in
individuals with obesity [11], but other studies found the
Profile of the gut microbiota of adults with obesity: a systematic review
Table 1 Characteristics, summary, and quality score of studies included in systematic review.
Author Country Characteristics of population n
Period (n men) BMI (kg/m²) age (years)
of study
Schwiertz Germany 98 individuals (♂ n = 34)
et al. [11] Age: 47 ± 13
Lean (n = 30 BMI 18.5–24.9)
Overweight (n = 35, BMI 25–30)
Obese (n = 33, BMI > 30)
Zuo et al. China 104 individuals
[33] Lean (n = 52, ♂ n = 26, BMI
20.26 ± 1.50, age 33.02 ± 10.37)
Obese (n = 52, ♂ n = 34, BMI
30.79 ± 2.80, age 34.65 ± 11.91)
Million et al. France 115 individuals
[41] Lean (n = 47, ♂ n = 24, BMI 22.1 ±
1.8, age 42.6 ± 17.5)
Obese (n = 68, ♂ n = 31, BMI
43.6 ± 7.8, age 50.5 ± 14.4)
Munukka Finland 85 women
et al. [40] Lean (n = 11, BMI 21.6 ± 2.0, age
31 ± 14)
Obese without metabolic disorder
(n = 47, BMI 29.1 ± 2.9, age 39 ± 9)
Obese with metabolic disorder
(n = 27, BMI 30.9 ± 2.9, age 42 ± 8)
Patil et al. India 20 individuals
[35] Underweight (n = 5, BMI 16.46 ±
1.34, median age 23)
Lean (n = 5, BMI 23.56 ± 0.82,
median age 44)
Obese (n = 5, BMI 44.62 ± 7.49,
median age 45)
Obese post bariatric surgery (n = 5,
BMI 31.63 ± 3.68, median age 50)
Bezerra et al. Brazil October ♀ n = 32
[18] to April Lean (n = 13, BMI 21.9 ± 2.1, age
26 (24–27))
Obese (n = 19, BMI 45.8 ± 4.7, age
34 (31–47))
Kocelak Poland 80 individuals
et al. [12] Lean (n = 30, BMI 23.2 (22.5–23.9),
age 42.6 (38.1–47.1))
obese (n = 50, BMI 35.7
(34.3–37.1), age 51.9 (48.1–55.7))
Million et al. France 263 individuals
[14] Anorexia (n = 15, ♂ n = 1, BMI
13.5 (11.7–14.6), age 27.3 ± 10.8)
Lean (n = 76, ♂ n = 40, BMI 22.4
(20.7–23.7), age 49.5 ± 18.6)
Overweight (n = 38, ♂ n = 32, BMI
27.1 (25.9–28.6), age 54.1 ± 17.8)
Obese (n = 134), ♂ n = 65, BMI
40.0 (36.4–46.8), age 51.8 ± 14.7
Method of gut microbiota evaluation
(bacteria analyzed)
qPCR (Clostridium leptum, Clostridium
coccoides, E. cylindroide, Lactobacilli/
Enterococci, Ruminococcus flavefaciens
spp., Veilonella, Bacteroides,
Prevotella, Bifidobacterium,
Methanobrevibacter)
Quantification of bacteria isolated from
feces and incubated (Escherichia coli,
Enterococci, Lactobacilli,
Bifidobacteria, Clostridium perfringens,
Bacteroides)
qPCR (Methanobrevibacter smithii,
Bacteroidetes, Firmicutes,
Lactobacillus, Lactococcus latis, and
Bifidobacterium)
Flow cytometry, 16S rRNA
hybridization, and DNA staining
(Atopobium cluster, Bacteroides group,
Bifidobacterium spp., enteric bacteria,
Eubacterium rectale- Clostridium
coccoides group, and Faecalibacterium
prausnitzii)
Sequencing and qPCR (Archaea and
Bacteroides)
Quantification of bacteria isolated of
feces and incubated (Bifidobacterium
spp. and Lactobacillus spp.)
Quantification of bacteria isolated of
feces and incubated (Bacteroides
ovatus, Clostridium septicum,
Clostridium perfringens, staphylococcus
aureus, echerichia coli)
qPCR (Firmicutes, Bacteroidetes,
Escherichia coli, Metanobevibacter
smithii, Latobacillus reuteri,
Lactobacillus plantarum, Lactobacillus
hamnosus, Lactobacillus fermentum and
Lactobacillus acidophilus,
Bifidobacterium animalis)
Outcomes NOS score
Ruminococcus flavefaciens spp, 8
Firmicutes, and Firmicutes/
Bacteroidetes ratio were lower and
Bacteroidetes higher in individuals with
overweight and obesity, and
Bifidobacterium, Methanobrevibacter
and Clostridium leptum were lower in
individuals with obesity, compared
with lean.
Positive correlation between BMI and
Bifidobacterium, Methanobrevibacter.
Bacteroides and Clostridium 8
perfringens were lower in individuals
with obesity. Enterococci tended to be
higher in individuals affected by obesity
(no significance).
Individuals with obesity showed lower 7
Methanobrevibacter smithii,
Lactobacillus paracasei, Lactobacillus
plantarum and Bifidoacterium animalis,
and higher Lactobacillus and
Lactobacillus reuteri, compared
with lean.
Lactobacillus reuteri increased,
Bifidobacterium animalis and
Methanobrevibacter smithii decreased
were associated with obesity.
Women with obesity and metabolic 7
disorder showed higher Eubacterium
rectale-Clostridium coccoides,
Firmicutes/Bacteroidetes ratio and
Eubacterium rectale/Bacteroidetes
compared with other groups and higher
gram-negative bacteria compared with
lean only. Eubacterium rectale/
Bacteroidetes ratio was higher in
women affected by obesity without
metabolic disorder compared with lean.
Positive correlation between BMI and
Eubacterium rectale-Clostridium
coccoides and Eubacterium rectale/
Bacteroidetes ratio, and negative
correlation between BMI and
Bacteroides.
Archaea and Bacteroides were higher in 5
individuals with obesity, decreasing
after bariatric surgery and becoming like
the lean individual.
No difference in gut microbiota 6
composition between different
nutritional status.
Individuals with obesity showed higher 5
bacteria total. Gram-positive and gram-
variables cocci only cultured on fecal
sample of obese.
Lactobacillus reuteri was higher in 5
individuals with overweight and obesity
and Lactobacillus reuteri was associated
with overweight and obesity.
Bacteroidetes and Escherichia coli were
lower in individual with obesity
compared with overweight and lean, and
Metanobrevibacter smithii and
Bifidobacterium animalis were lower

Table 1 (continued)
Author Country Characteristics of population n
Period (n men) BMI (kg/m²) age (years)
of study
Simões et al. Finland Years: 20 twin pairs (♂ pairs n = 9)
[17] 1975–1979 Lean (BMI 22.9 ± 2.2, age 26 ± 3)
Overweight (BMI 26.5 ± 1.2, age
29 ± 3)
Obese (BMI 32.74 ± 2.1, age 28 ± 4) Atopobium (A. parulim),
Teixeira Brazil ♀ n = 32
et al. [39] Lean (n = 17, BMI 21.2 (20.6–21.9), Bifidobacterium catenulatum,
age 28.05 ± 6.9)
Obese (n = 15, BMI 34,5
(32.8–36.7), age 30.7 ± 5.7)
Verdam et a. Netherland 28 individuals
[24] May to Lean (n = 9, ♂ n = 3, BMI 22.2 ±
September 0.7, age 23.3 ± 3.3)
Obese (n = 19, ♂ n = 5, BMI 40.4 ±
2.5, age 36.2 ± 2.4)
Zak-Golab Poland 80 individuals
et al. [19] Lean (n = 30, ♂ n = 6, BMI 23.7
(21.8–24.8), age 42.5 (32.0–52.0))
Obese (n = 50, ♂ n = 11, BMI 35.4
(30.6–38.7), age 53.5 (42.0–63.0))
Escobar et al. – 126 individuals
[34] Colombian (n = 30, ♂ n = 16 - Lean
(BMI 22.6 ± 1.7, age 33 ± 11),
Overweight (BMI 27.1 ± 1.3, age
39 ± 9), Obese (BMI 32.6 ± 2.3, age
43 ± 12))
European (n = 13, ♂ n = 10 - Lean
(BMI 22.5 ± 1.2, age 56 ± 9),
Overweight (BMI 28.4 ± 0.8, age
56 ± 9), Obese (BMI 32.8 ± 1.7, age
59 ± 6))
Japanese (n = 11, ♂ n = 5 - Lean
(n = 10, BMI 20.1 ± 0.8, age 21 ± 1),
Overweight (n = 1, BMI 28, age 33))
South Korea (n = 18, ♂ n = 12 -
Lean (n = 14, BMI 22.5 ± 1.2, age
43 ± 16), Overweight (n = 4, BMI
28.5 ± 0.6, age 58 ± 13))
USA (♀ n = 54 twin - Lean (BMI
21.3 ± 1.0, age 26 ± 2), Overweight
(BMI 28.3 ± 0.6, age 26 ± 3), Obese
(BMI 41.7 ± 7.8, age 26 ± 3))
Fernandes Canada 94 individuals
et al. [42] Lean (n = 52, ♂ n = 22, BMI 21.8 ±
0.3, age 32.0 ± 1.8)
Overweight and obese (n = 42, ♂
n = 21, BMI 30.3 ± 0.7, ager 37.9 ±
2.0)
Rahat- Canada 22 individuals
rozenbloo Lean (n = 11, ♂ n = 6, BMI 22.6 ±
et al. [28] 0.6, age 35.8 ± 4.2)
Method of gut microbiota evaluation
(bacteria analyzed)
qPCR (Bacteroides spp. (Bacteoroides
thetataiotaomicron), E. rectale
(Roseburia intestinalis), C. leptum
(Anaerotruncus colibominis),
Bifidobacterium, (B. longum)
Lactobacillus (Lactobacillus casei))
qPCR (Bifidobacterium longum,
Bifidobacterium bifidum,
Bifidobacterium adolescentis,
Bifidobacterium breve, Akkermansia
muciniphila, Clostridium coccoides,
Clostridium leptum, Lactobacillus
acidophilus, Lactobacillus paracase,
Lactobacillus plantarum, Lactobacillus
rhamnosus, Lactobacillus casei)
Sequencing
Quantification of bacteria isolated of
feces and incubated (Bacteroides ovatus composition between different
ATCC BAA-1296, Clostridium
septicum ATCC 12464, Clostridium
perfringens ATCC 13124,
Staphylococcus aureus ATCC 25923,
and Escherichia coli ATCC 25922)
Sequencing
qPCR (Bacteroidetes/Prevotella
(Bacteroidetes), Clostridium coccoides,
Clotridium leptum, Bifidobacteria,
Escherichia coli, Archea)
Sequencing
L. Crovesy et al.
Outcomes NOS score
compared with lean.
Negative correlation between BMI and
Bifidobacterium animalis, Escherichia
coli.
No difference in gut microbiota 9
composition between different
nutritional status.
Women with obesity showed lower 6
Bifidobacterium, Bifidobacterium
longum, Clostridium coccoides and
Clostridium leptum. Lactobacillus
plantarum and Akkermansia (p = 0.006)
tended to be lower.
Negative correlation between BMI and
Akkermansia muciphinila,
Bifidobacterium, Bifidobacterium
longum, Clostridium coccoides,
Clostridium leptum, Lactobacillus
plantarum.
Individuals with obesity showed lower 7
diversity and Bacteroidetes/Firmicutes
ratio, and higher amount of Clostridium
cluster IV and XIVa.
Negative correlation between BMI and
Bacteroidetes/Firmicutes ratio,
Allistipes, and positive correlation
between BMI and Roseburia
intestinalis, Enterobacter aerogenes,
Klebsiella pneumniea, Vibrio,
Yersina spp.
No difference in gut microbiota 5
nutritional status.
Americans with obesity showed lower 7
Firmicutes, Bacteroides, Coprococcus,
Oscillospira, Parabacteroides,
Clostridiales, Rikenellaceae,
Ruminococcaceae, and higher
Catenibacterium, while Colombians
affected with obesity showed lower
Ruminococcaceae, Clostridiales,
Dialister, Oscillospira, Akkermansia.
Europeans with obesity showed lower
Bacteroides and higher Veillonellaceae.
Individuals with overweight and obesity 7
showed lower Escherichia coli.
Negative correlation between BMI and
Bacteroidetes.
Individuals with obesity showed higher 8
Firmicutes and Firmicutes/
Bacteroidetes ratio.
Profile of the gut microbiota of adults with obesity: a systematic review

Table 1 (continued)
Author Country Characteristics of population n Method of gut microbiota evaluation Outcomes NOS score
Period (n men) BMI (kg/m²) age (years) (bacteria analyzed)
of study

Obese (n = 11, ♂ n = 9, BMI 30.1 ±

0.8, age 42.5 ± 3.9)
Dorminianni USA April 82 individuals (♂ n = 51) Sequencing Women with overweight had lower 9
et al. [20] 1985 to ♀ (n = 31, BMI 23.8 ± 4.69, age diversity.
June 1987 59.2 ± 12.67)
♂ (n = 51, BMI 25.0 ± 4.06, age
58.4 ± 13.18)
Kasai et al. Japan 56 individuals Terminal restriction fragment length Individuals with obesity showed higher 7
[26] 2012–2013 Lean (n = 23, ♂ n = 11, BMI 18.6 ± polymorphism diversity, richness, Firmicutes/
1.2, age 45.6 ± 9.6) Bacteroidetes ratio, and lower amounts
obese (n = 33, ♂ n = 20, BMI of Bacteroidetes.
27.8 ± 2.5, age 54.4 ± 8.2) Blautia hydrogenotorophica,
Coprococcus catus, Eubacterium
ventriosum, Ruminococcus bromiii and
Ruminococcus obeum were associated
with obesity.
While Bacteroidetes faecichinchilar,
Bacteroides thetaiotaomicron, Blautia
wexlerae, Clostridium bolteae,
Flavonifractor plautii. Bacteroidetes
faecichinchil and Bacteroides
thetaiotaomicron were associated
with lean.
Santos et al. Brazil October ♀ n = 40 qPCR (Mollicutes classes, Firmicutes Women with obesity showed higher 8
[29] to December Lean (n = 20, BMI 22.41 ± 2.04, age and Bacteroidetes) amount of Mollicutes and Firmicutes/
44 ± 9.3) Bacteroidetes ratio.
Obese (n = 20, BMI 36.45 ± 4.52, Positive correlation between BMI and
age 33 ± 12.04) Mollicutes.
Yasir et al. Saudi Arabia 46 individuals Sequencing Lean French showed higher bacterial 6
[13] and France Saudi (♂ n = 18 men – Lean (n = 9, species than other groups.
BMI 24.5 ± 3.2, age 28 ± 4), Obese French with obesity showed higher
(n = 9, BMI 46.0 ± 5.9, age 26 ± 3)) Proteobacteria, Bacteroidetes,
French (n = 28 – Lean (n = 16, ♂ Lactobacillus, Escherichia-Shiguela,
n = 7, BMI no data, age 34 ± 5), Bacteroides, Bacteroides fragilis,
Obese (n = 12, ♂ n = 7, BMI 38.3 ± Blautia wexlerae, Echerichia coli and
7.9, age 39 ± 13)) lower Clostridium, Faecalibacterium,
Bifidobacterium adolescentis, breve,
and Ruminococcus lactaris compared
with lean French, and lower
Ruminococcus, Verrucomicrobia,
Faecalibacterium, Bifidobacterium
adolescentis, and higher Bacteroides
fragilis, and Bifidobacterium bifidum
compared with lean Saudi.
Saudi with obesity showed higher
Firmicutes and Dorea compared with
lean Saudi, and lower Clostridium,
Bifidobacterium brevee and higher
Dorea, Blautiawex lerae and Rothia
mucilaginosa compared with lean
French.
Gemmatimonadetes, Lactobacillus
gasseri and reuteri were detected only
French with obesity, and Spirochaetae
and Elusimicrobia detected only lean
French.
French with obesity had higher
Verrucobacteria, Rothia mucilaginosa
and Ruminococcus bromii, and lower
Faecalibacterium, Blautia and
Bifidobacterium compared with Saudi
with obesity.
Andoh et al. Japan 20 individuals Sequencing Individuals with obesity showed higher 6
[32] Lean (n = 10, ♂ n = 5, BMI 16.6 ± Firmicutes, Fusobacteria, Alistipes,
1.0, age 45 (31–58)) Anaerococcus, Coprococcus,
Obese (n = 10, ♂ n = 5, BMI 38.1 ± Fusobacterium, Parvimonas,
3.5, age 41 (35–55)) Acidaminococcus intestine, Actinomyces
meyeri, Atopobium parvulum,
Bacteroides vulgates, Eubacterium
hadrum, Klebsiella pneumonia,
Roseburia faecis and lower Bacteroides,
Desulfovibrio, Faecalibacterium,
Finegoldia, Lachnoanaero baculum,
 L. Crovesy et al.

Table 1 (continued)
Author Country Characteristics of population n Method of gut microbiota evaluation Outcomes NOS score
Period (n men) BMI (kg/m²) age (years) (bacteria analyzed)
of study

Olsenella, Clostridium ramosum,

Clostridium citroniae, Faecalibacterium
prausnitzii, Eubacterium desmolans,
Eubacterium fissicatena, and
Haldemania filiformis.
Hippe et al. – 68 individuals qPCR (Faecalibacterium prausnitzii) Individuals with obesity with or without 5
[43] Lean (n = 18, ♂ n = 3, BMI 21.2 ± T2D showed lower Faecalibacterium
1.9, age 26 ± 3) prausnitzii compared with lean.
Obese with T2D (n = 24, ♂ n = 14,
BMI 38.2 ± 5.1, age 58 ± 9)
Obese (n = 26, ♂ n = 4, BMI 43.9 ±
12.1, age 42 ± 15)
Selma et al. Spain 69 individuals qPCR (Echerichia coli, Bifidobacterium Individuals with overweight-obesity 5
[30] Clinical trial Lean (n = 20, ♂ n = 11, BMI 22.5 ± (B. longum), Lactobacillus/ showed higher Firmicutes, Clostridium
2.1) Leuconostoc/Pedicoccus (Lactobacillus leptum, Lactobacillus/Leuconostoc/
Overweight-obesity (n = 49, ♂ n = plantarum), Firmicutes, Clostridium Predicoccus, Bifidobacterium and
32, BMI 30.3 ± 3.4) leptum, Blautiacoccoides/ Firmicutes/Bacteroidetes ratio, and
Eubacteriumrectale (Blautia coccoides), lower Prevotella.
Bacteroides (Bacteroides ovatus), Positive correlation between BMI and
Prevotella (Prevotella bucalis), and Firmicutes, Clostridium leptum,
Gordonibacter (Gordonibacter Lactobacillus/Leuconostoc/Predicoccus,
pamelaeae)) and negative correlation between BMI
and Prevotella.
Blasco et al. Spain January 35 individuals Sequencing Individuals with obesity showed lower 6
[37] to September Lean (n = 18, ♂ n = 10, BMI 23.3 Ignavibacteriae.
(21.6–25.82), age 50 (39–56.25))
Obese (n = 17, ♂ n = 11, BMI 45.1
(39.1–47.45), age 53 (48–58))
Davis et al. USA May to 81individuals, ♂ n = 36 Sequencing Firmicutes (Dialister sp., Ruminococcus 8
[45] December BMI 28.3 ± 7.0 gnavus, Blautiaobeum,
Lean (27) Megasphaerasp., Oscillospira sp.) and
Overweight (27) Verrucobacteria (Akkermansia
Obese (27) muciniphila) had association with
Age 33 ± 13.3 obesity.
Fernandéz- Spain 2009 68 individuals qPCR (Akkermansia (Akkermansia Lactobacillus was higher in individuals 9
Navarro et al. to 2015 Lean (n = 20, ♂ n = 4, BMI 23.0 ± muciniphila CIP 107961), Bacteroidetes with obesity.
[21] 1.5, age 56.4 ± 10.1) group and Bacteroidetes-Prevotella- Positive correlation between BMI and
Overweight (n = 35, ♂ n = 17, BMI Porphiromonas (Bacteroides Lactobacillus.
27.5 ± 1.4, age 51.7 ± 11.7) thetaiotaomicron DSMZ 2079),
Obese (n = 13, ♂ n = 6, BMI 34.1 ± Bifidobacterium (Bifidobacterium
2.7, age 47.8 ± 10.2) longum NCIMB 8809),
Faecalibacterium (Faecalibacterium
prausnitzii DSMZ 17977), Clostridia
XIVa and Blautia coccoides-
Eubacterium rectale (Blautia coccoides
DSMZ 935), Lactobacillus group
(Lactobacillus gasseriIPLA IR7/5))
Kolida et al. Ukraine 61 individuals qPCR (Bacteroidetes, Firmicutes, Individuals with obesity showed lower 6
[10] March to May Underweight (n = 7, ♂ n = 2, Actinobacteria) Bacteroidetes and higher Firmicutes and
BMI < 18.5) Firmicutes/Bacteroidetes ratio.
Lean (n = 27, ♂ n = 7, BMI Positive correlation between BMI and
18.5–24.9) Firmicutes and Firmicutes/
Overweight (n = 16, ♂ n = 2, BMI Bacteroidetes ratio, and negative
25–29.9) correlation between BMI and
Obese (n = 11, ♂ n = 4, BMI ≥ 30) Bacteroidetes.
Age 44.2
Nistal et al. Spain 73 individuals Sequencing Individuals with obesity showed higher 7
[27] Lean (n = 20) bacterial richness and amount of
Obese (n = 53) Proteobacteria, Prevotella,
No data about BMI Megasphaera, Lactobacillus,
Age (20–60) Meganomas and Acidaminococcus, and
lower amount of Blautia, Osillospira,
Flavobacterium, Alkaliphillys and
Eubacterium, compared with lean.
De la Cuesta- Colombia July 441 individuals Sequencing Diversity was lower in individuals with 6
Zuluaga et al. to November Healthy lean (n = 91, ♂ n = 41, BMI obesity and individuals with
[25] 22.5 ± 1.6, age 36.8 ± 10.8) cardiovascular disease.
Non-healthy lean (n = 47, ♂ n = 22, Pathobiont-CAG and Lachnospiraceae-
BMI 23.0 ± 1.6, age 43.3 ± 11.8) CAG were associated with
Healthy overweight (n = 60, ♂ n = cardiovascular disease and obesity,
26, BMI 27.2 ± 1.3, age 38.4 ± 10.8)
Profile of the gut microbiota of adults with obesity: a systematic review

Table 1 (continued)
Author Country Characteristics of population n Method of gut microbiota evaluation Outcomes NOS score
Period (n men) BMI (kg/m²) age (years) (bacteria analyzed)
of study

Non-healthy overweight (n = 111, ♂ while Ruminococcaceae and

n = 63, BMI 27.6 ± 1.4, age 41.5 ±
10.9)
Healthy obese (n = 21, ♂ n = 6,
BMI 33.5 ± 2.6, age 43.1 ± 8.8)
Non-healthy obese (n = 111, ♂ n =
54, BMI 34.1 ± 3.6, age 42.7 ± 11.1)
Gao et al. China 551 individuals
[36] Underweight (n = 62 ♀ n = 49,
♂ n = 13, BMI ♀ 17.5 ± 1.0, ♂
16.7 ± 1.1, age ♀ 38.0 ± 25.6, ♂
21.5 ± 5.5)
Lean (n = 261 ♀ n = 168, ♂ n = 93,
BMI ♀ 20.7 ± 1.3, ♂ 21.3 ± 1.3, age
♀ 35.6 ± 14.3, ♂ 37.8 ± 17.3)
Overweight (n = 170 ♀ n = 55,
♂ n = 115, BMI ♀ 24.7 ± 1.3, ♂
25.1 ± 1.2, age ♀ 38.1 ± 12.6, ♂
41.7 ± 15.9)
Obese (n = 58 ♀ n = 20, ♂ n = 38,
BMI ♀ 31.7 ± 4.3, ♂ 31.2 ± 3.2, age
♀ 35.5 ± 4.3, ♂ 34.7 ± 3.2)
Jinatham Thailand 42 individuals
et al. [31] Lean (n = 21, BMI 20.7 ± 0.4)
Overweight (n = 10, BMI 27.4 ±
0.5)
Obese (n = 11, BMI 33.6 ± 1.0)
Age 27.6 ± 1.3
Ottosson Sweden 674 individuals
et al. [44] Lean (BMI 22.3 ± 1.8)
Overweight (BMI 27.1 ± 1.4)
Obese (BMI 33.6 ± 3.3) Age 39.4 ±
13.5
Sarmiento Brazil 72 individuals
et al. [38] Lean (n = 24, BMI 22.2 ± 1.8)
Overweight (n = 24, BMI 27.1 ±
1.3)
Obese (n = 24, BMI 36.9 ± 6.0)
Age 39.6 ± 13.5
Sequencing
qPCR (Bacteroidetes, Bacteroides,
Prevotella, Firmicutes, Roseburia e
Eubacterium rectale, Ruminococcus,
Lactobacillus, Enterococcus,
Staphylococcus, Oscillospira,
Faecalibacterium prausnitzii,
Chistensenella minuta, Actinobacteria,
γ-Proteobacteria, Fusobacterium,
Akkermansia muciniphila,
Methanobacteria)
Sequencing
FISH (Bacteroidetes fragilis,
Escherichia cpli, Enterococcus,
Fusobacterium, Prevotella intermedia,
prevotella nigrescens, Pseudomonas,
Staphylococcus, Streptococcus,
Acinetobacter)
Akkermansia were associated with lean.
Underweight showed higher alpha 7
diversity compared with the other
groups. Bacteroidetes, Fusobacteria and
Proteobacteria were higher in
individuals with obesity, compared with
underweight.
Bacteroidetes, Firmicutes, 8
Staphylococcus, Akkermansia
muciniphila, Methanobacteria were
lower in individuals with obesity,
compared with lean. Ruminoccocus,
Christensenella minuta, γ-
Proteobacteria, Akkermansia
municiphila was lower in individuals
affected by obesity, compared with
overweight.
Negative correlation between BMI,
waist circumference and Firmicutes,
Staphylococcus, Akkermansia
municiphila, Methanobacteria.
Positive correlation between BMI and 7
Lachnospiraceae (Blautia, Dorea, and
Ruminococcus), and negative
correlation between BMI and SHA-98.
Individuals with obesity showed higher 8
bacterial density followed by individuals
with overweigh and lean.
Fusobacterium, Enterococcus,
Echerichia coli were higher in
individuals with obesity, compared with
lean individuals.

♀ women, ♂ men, BMI body mass index, DNA desoxyribonucleic acid, FISH fluorescence in situ hybridization, NOS Newcastle–Ottawa Scale,
rRNA ribosomal ribonucleic acid, qPCR quantitative polymerase chain reaction quantitative, T2D type 2 diabetes, USA United State of America.

inverse result, with higher Firmicutes/Bacteroidetes ratio in
individual with obesity [10, 24, 26, 28–30].
Microbiota profile and obesity
Individuals with obesity showed higher Firmicutes counts
[10, 13, 28, 30–32] and lower Bacteroidetes counts
[10, 14, 26, 32–34]. However, some studies found lower
Firmicutes [11, 34] and higher Bacteroidetes
[11, 13, 31, 35, 36] in individual with obesity. Fusobacteria
[32, 36] and Proteobacteria [13, 27, 36] phyla increased,
while the Ignavibacteriae [37] and Verrucobacteria
(Akkermansia municiphila) [13] decreased. In addition, one
study showed higher counts for the Archaea kingdom [32],
and another study found higher Mollicutes class [29], while
a third showed lower Methanobacteria [31] in individuals
with obesity.
Rikenellaceae, Ruminococcaceae, and Veillonellaceae
families were less present in individuals with obesity [34]. At
the genus level, individuals with obesity had higher count of
Alistipes, Anaerococcus, Coprococcus, Parvimonas [32],
Fusobacterium [32, 38], Enterococcus [38], Prevotella,
Megasphaera, Meganomas, Acidaminococcus [27], Bifido-
bacterium [30, 39], Lactobacillus [13, 14, 21, 27], Cateni-
bacterium [34], Dorea, Bacteroides, Escherichia-Shiguela
[13], Lactobacillus/Leuconostoc/Predicoccus [30], and the
Eubacteriumrectale/Bacteroidetes ratio [40], and lower
counts of Desulfovibrio, Finegoldia, Lachnoanaerobaculum,

Identification
Records identified through 2615 records identified
database searching through grey literature
(n=9881)
Screening
Records after duplicates
removed (n=8336)
Eligibility
Full text assessed for
eligibility (n=53)
Included
Studies included in
qualitative synthesis (n=32)
Fig. 1 Flow chart of selection process.
Olsenella [32], Faecalibacterium [13, 32], Bifidobacterium,
Methanobrevibacter [11], Prevotella [30], Blautia, Flavo-
bacterium, Alkaliphillys, Eubacterium [27], Staphylococcus
[31], Osillospira [27, 34], Dialister, Akkermansia, Copro-
coccus, Parabacteroides, Clostridiales [34], Clostridium, and
Ruminococcus [13].
The species more present in individuals with obesity
were Lactobacillus reuteri [14, 41], Clostridium cluster IV
and XIVa [24], Clostridium leptum [30], Acidaminococcus
intestine, Actinomyces meyeri, Atopobium parvulum, Bac-
teroides vulgates, Eubacterium hadrum, Klebsiella pneu-
monia, Roseburia faecis [32], Bacteroides fragilis, Blautia
wexlerae, Escherichia coli, and Bifidobacterium bifidum
[13]. On the other hand, Akkermansia muciniphila [13, 31],
Clostridium leptum, Ruminococcus flavefaciens spp. [11],
Clostridium perfringens [33], Lactobacillus paracasei,
Lactobacillus plantarum [41], Methanobrevibacter smithii,
Bifidoacterium animalis [14, 41], Escherichia coli [14, 42],
Ruminococcus lactaris, Rothia mucilaginosa, Bifido-
bacterium adolescentis Bifidobacterium breve [13], Bifido-
bacterium longum, Clostridium coccoides, Clostridium
leptum [37], Clostridium ramosum, Clostridium citroniae,
Faecalibacterium prausnitzii [32, 43], Eubacterium des-
molans, Eubacterium fissicatena, and Haldemania filiformis
[32] were less present in individuals with obesity.
Correlation between gut microbiota and obesity
Some studies carried out correlations between the gut
microbiota composition and the BMI (n = 15). Positive
Records duplicates excluded
(n=4160)
Records excluded after reading
title and abstract (n=8283)
Full-text articles excluded (n=21):
−Short communication (n=2)
−Thesis was not available (n=1)
−Did not compared lean and obese
(n=4)
−Included children and teenagers
(n=2)
− Did not evaluated gut
microbiota (n=2)
−Intervention study (n=2)
−Obesity group had overweight
BMI (n= 5)
−Protocol (n=1)
−Poor quality (n=2)
L. Crovesy et al.
correlations were found between the BMI and Bifido-
bacterium, Methanobrevibacter [11], Eubacterium rectale-
Clostridium coccuides, Eubacterium rectale/Bacteroidetes
ratio [40], Roseburia intestinalis, Enterobacter aerogenes,
Klebsiella pneumniea, Vibrio, Yersina spp. [24], Mollicutes
[29], Firmicutes, Clostridium leptum, Lactobacillus/Leu-
conostoc/Predicoccus [30], Lactobacillus [21], Proteo-
bacteria, Actinobacteria, Spitochaetes, Blautia, Dorea,
Ruminococcus [44], and Firmicutes/Bacteroidetes ratio
[26].
Negative correlations were found between the BMI and
Bacteroides [40, 42], Clostridium coccoides, Clostridium
leptum, Lactobacillus plantarum, Bifidobacterium, Bifido-
bacterium longum [39], Akkermansia muciphinila [31, 39],
Firmicutes, Staphylococcus, Methanobacteria [31], Bifido-
bacterium animalis, Escherichia coli [14], Prevotella [30],
SHA-98 [44], Allistipes, and Bacteroidetes/Firmicutes ratio
[24].
Bacteroidetes faecichinchilar, Bacteroides thetaiotao-
micron, Blautia wexlerae, Clostridium bolteae, Flavoni-
fractor plautii [26], Ruminococcaceae, and Akkermansia
[25] were associated with normal weight. On the other
hand, increases in Blautia hydrogenotorophica, Copro-
coccus catus, Eubacterium ventriosum, Ruminococcus
bromii, Ruminococcus obeum [26], Firmicutes, Verruco-
bacteria [45] and Lactobacillus reuteri [14, 41], and
decreases in Bifidobacterium animalis and Methano-
brevibacter smithii were associated with obesity [41], and
Pathobiont-CAG and Lachnospiraceae-CAG were asso-
ciated with cardiovascular disease and obesity [41].
Discussion
Over the years the role that the gut microbiota composition
exerts on human health influencing body weight control,
has been shown [46]. This review observed controversy in
the diversity of the gut microbiota associated with obesity
with respect to higher or lower counts in individual with
obesity, compared with lean. Some bacteria of the gut
microbiota were highlighted as higher in individual with
obesity, such as Firmicutes, Proteobacteria, Fusobacteria,
Firmicutes/Bacteroidetes ratio, and Lactobacillus, and oth-
ers as lower, such as Bacteroidetes, Faecalibacterium
prausnitzii, Akkermansia muciniphila, Methanobrevibacter
smithii, and Bifidobacterium animalis.
The relationship between the gut microbiota and body
weight control was discovered in the last decade [6]. Later a
study showed weight gains in germ-free mice receiving
transplants of gut microbiota from individuals with obesity
[47]. The literature indicates an important influence of the
microbiota on body weight control. This changes in the gut
microbiota composition causes a greater extraction and
Profile of the gut microbiota of adults with obesity: a systematic review
absorption of calories, a reduction in the secretion of the
anorexigenic hormones (GLP-1, PYY, and leptin) and
satiety, increases fat storage in the adipose tissue, and
damage to the gut barrier contributing with translocation of
lipopolysaccharide and inflammation. These changes con-
tribute to the development of obesity [46, 48]. Although the
mechanism causing an imbalance in the gut microbiota is
known, the bacteria involved in this process have not been
determined yet [48].
The relationship between Firmicutes/Bacteroidetes ratio
and obesity appears to have also been confirmed in humans.
Only one study showed lower Firmicutes/Bacteroidetes
ratio in individuals with obesity; however, these authors
considered Bacteroides and Prevotella as Bacteroidetes
phylum [11], which may have resulted in this phylum being
overestimated. Firmicutes and Bacteroidetes are dominant
in the gut microbiota, corresponding to 90% of bacteria [4].
The Bacteroidetes have been associated with adequate body
weight but the Firmicutes with obesity. The Bacteroidetes
have a positive correlation with a reduction of body fat [2],
whereas the relationship between Firmicutes and obesity
can be associated with a greater energy harvest. The Fir-
micutes have more carbohydrate metabolism enzymes,
which contribute to the metabolization of this macronutrient
allowed for a greater energy absortion [49].
Lactobacillus genus belongs to Firmicutes phylum, an
increase in this genus has been associated with obesity [49].
Amongst the bacteria of this genus, Lactobacillus reuteri
[14, 40] has been correlated with a higher BMI. However,
despite the association between Lactobacillus and obesity, it
appears that some of the bacteria (Lactobacillus paracasei
and Lactobacillus plantarum) of this phylum have a pro-
tective effect against weight gain. Lactobacillus paracasei
and Lactobacillus plantarum produce bacteriocins with
antibacterial action, preventing the growth of bacterial
pathogens that cause dysbiosis [50].
The Proteobacteria is associated with dysbiosis, leading
to metabolic diseases such as obesity. When the Proteo-
bacteria increases there is a reduction in mucus production
causing damage to the gut barrier and a low-grade inflam-
mation [51]. Fusobacteria and Fusobacterium are oppor-
tunist pathogenic bacteria, increasing in individuals with
obesity. This result was also found by Goa et al. [23].
Faecalibacterium prausnitzii is a butyrate producing
bacterium with anti-inflammatory and protective effects
against obesity [52]. Akkermansia muciniphila (Verruco-
microbia) is involved in the metabolism of mucin,
degrading and stimulating the mucin in host gut. Besides
the control of mucus, this bacterium also interacts with the
host metabolism, maintaining the integrity of the intestinal
barrier, and modulating other bacteria of the gut microbiota,
favoring eubiosis [53].
The presence of divergent results between different stu-
dies can be caused by many factors, such as the techniques
used to analyze the gut microbiota, different primer designs
and different DNA extraction techniques [11, 54], the
population studied, diet, gender, latitude of the study site,
and the season. The gut microbiota is easily affected, and it
is difficult to control all the elements that affect the gut
microbiota composition [55]. Most studies did not evaluate
the components that influence the gut microbiota, and
therefore it is difficult to understand the possible differences
found between the results of the different studies.
Amongst these factors, the diet appears to have a greater
influence on the gut microbiota composition. Thus, the
focus of the present article was a comparison between the
gut microbiota of individuals with obesity and normal
weight individuals, who have different dietary patterns. In
addition, the studies were carried out in different countries
with distinct food habits that affect the gut microbiota
composition [55]. Most of the studies were carried out with
single population except those of Yasir et al. [13] and
Escobar et al. [34]. From the information reported in these
articles, it was possible to show different dietary patterns
exerted different influences on the gut microbiota compo-
sition, not only on body weight, making the study of the
microbiota with respect to obesity more complex.
Other important point to discuss is the metabolites pro-
duces by the bacteria of the microbiota. Of the metabolites
highlighted, the short-chain fatty acids can exert different
effects on the host and can help or hinder the host meta-
bolism. Short-chain fatty acids influence the metabolism of
energy, lipids, glucose, and cholesterol, in addition con-
tribute to fat storage in the adipose tissue and the immune
system function [56]. Patil et al. [35] observed that the gut
microbiota of individuals with obesity produced twice as
much short-chain fatty acids as compared with that of lean
individuals, propionate being present in the greatest pro-
portion [11]. Few studies have explored the role of meta-
bolites in the host metabolism.
Furthermore, the impact of the gut microbiota composi-
tion on body weight must be considered. Although some
studies have associated alterations in the gut microbiota
with metabolic changes, leading to weight gain and con-
sequently to the development of obesity [2, 8, 9], there are
still doubts as to whether obesity leads to changes in the gut
microbiota composition or whether changes in the gut
microbiota lead to obesity [57]. Studies evaluating the
impact of weight loss in individual with obesity have shown
changes in the gut microbiota [58, 59]. Pajecki et al. [59]
showed alteration in the gut microbiota composition in
individual with severe obesity after bariatric surgery, and
the bacteria showed different contributions to the weight
loss process. In addition, the diet appears to have greater

impact on changes in the gut microbiota than surgery alone
[60].
From the gut microbiota composition can predict the
results of the intervention on weight loss. In addition,
knowledge of the microbiota composition of individual with
obesity can maximize the weight loss produced by a per-
sonalized diet [58]. It is undeniable that the gut microbiota
is related to obesity, and that weight loss interventions
reflect on changes in the microbiota [58]. It is important to
understand the role of the bacteria involved in the obesity
process and how can change this scenario to generate
weight loss in individuals with overweight.
Conclusion
Individual with obesity showed different gut microbiota
profiles the those of individuals with normal weight. Indi-
viduals affected by obesity had higher counts of Firmicutes,
Fusobacteria, Proteobacteria, and Lactobacillus, and lower
counts of Bacteroidetes, Akkermansia muciniphila, Faeca-
libacterium prausnitzii, Lactobacillus plantarum, and Lac-
tobacillus paracasei. In addition, an increase in the
Firmicutes/Bacteroidetes ratio appeared to be related to
obesity, as in animal studies.
The results found in this systematic review indicated the
possible involvement of bacteria in the development of
obesity, guiding the choice of strain probiotics for gut
microbiota modulation in the treatment of obesity. How-
ever, the study of the microbiota is complex, and it is dif-
ficult to define a standard for the gut microbiota
composition in populations or in specific groups. Many
factors influence the microbiota composition, such as sea-
son, diet, exercise, drugs, country, and gender. Some of
these factors cannot be controlled, but with advances in the
science of the microbiota and analytical techniques, it will
be possible to discover the role that each bacterium plays in
the human metabolism and in the disease-health process.
Funding This research was financed in part by the Coordenação de
Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—
Finance code 001, and Fundação de Amparo à Pesquisa do Estado do
Rio de Janeiro (Faperj). The funders were not involved in the design
until publication of study.
Author contributions LC and ELR: conceived and design of the study;
LC and DM: protocol of search and acquisition of data; LC: drafting
the article; All authors: revised and approval of the version to be
submitted.
Compliance with ethical standards
Conflict of interest The authors declare that they have no conflict of
interest.
L. Crovesy et al.
Publisher’s note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.
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