Menopause-related changes in the gut microbiome and their association with cardiometabolic diseases in women from four sub-Saharan African countries

Abstract

Menopause is associated with an increased risk of cardiometabolic diseases (CMDs). Existing research suggests that the gut microbiome (GM) may mediate this relationship through its response to changing hormone levels. However, this association remains understudied in African populations, where CMD burden is increasing. This study aimed to investigate compositional differences in the GM between pre- and postmenopausal women in sub-Saharan Africa and their association with CMDs. The study analysed the gut microbial composition of 1232 women from six sites across four sub-Saharan African countries. Microbial diversity was assessed using Inverse Simpson index and Bray-Curtis dissimilarity and differentially abundant taxa between menopausal groups were identified using Linear discriminant analysis Effect Size. Our analysis revealed that CMD status emerged as a stronger determinant of gut microbial diversity than menopausal status. Women with CMDs showed significantly lower microbial diversity regardless of menopausal status. Geographic location also significantly influenced GM composition, with substantial variations across study sites. Taxonomically, premenopausal women were enriched with beneficial short-chain fatty acid-producing bacteria, including Faecalibacterium prausnitzii, Bacteroides fragilis, and Prevotella, while postmenopausal women exhibited both beneficial (Ruminococcus champanellensis) and potentially harmful species (Collinsella bouchesdurhonensis). Rather than menopause directly altering the GM and subsequently increasing the risk of CMDs, our findings suggest that the higher prevalence of CMDs in postmenopausal women may be driving of the observed changes in the microbiome. These findings highlight the importance of population-specific approaches to women's health research and understanding the complex interplay between hormonal status, GM, and metabolic health in African women