The Role of Fermented Pickles in Shaping Gut Microbiota and Immune Response in Women: A Community-Based Trial in Pakistan

A gut microbiome-targeted diet can potentially mitigate chronic diseases like malnutrition. In a prospective 12-week intervention trial, we evaluated the effects of six different plant-based fermented pickles (∼50g/day) on clinical, inflammatory, and gut-microbiome parameters in women (n=230) in a rural setting with a high prevalence of undernutrition. Blood was collected at two, whereas stool was collected at three timepoints. Among fecal biomarkers, myeloperoxidase (MPO), Lipocalin-2 (LCN2), and 16S rRNA sequencing were measured at baseline, 8 ^th, and 12 ^th weeks. Overall compliance rate was >70%. WBC and neutrophils significantly decreased among radish (p=0.002, p=0.01) and carrot (p=0.005, p=0.006) groups compared to controls. In lemon-chili groups, platelets significantly decreased (p<0.001) while MCV increased (p=0.02). In onion and lemon-chili groups, the alpha (р=0.001 and p=0.0005, respectively) and beta diversities (p=9e-04 and p=0.0223, respectively) were significantly increased. Post-intervention linear discriminant analysis (LDA) identified 25 bacterial taxa markers at 8 ^th and 12 ^th week, that included Eggerthellaceae and Oscillospiraceae, Erysipelatoclostridiaceae and Subdoligranumlum, predominantly in lemon-chili group. Correlation analysis revealed six taxa negatively associated with inflammatory markers such as CRP, LCN2, and platelets. Our study provides preliminary information about consumption of culturally acceptable fermented pickles exerting beneficial changes in hematological and gut microbiome profiles of women, post-intervention.